Healthcare Provider Details

I. General information

NPI: 1043027634
Provider Name (Legal Business Name): GARDEN STATE SPORTS MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2024
Last Update Date: 04/04/2025
Certification Date: 04/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3799 ROUTE 46 STE 110
PARSIPPANY NJ
07054-1060
US

IV. Provider business mailing address

3799 US HIGHWAY 46 STE 110
PARSIPPANY NJ
07054-1060
US

V. Phone/Fax

Practice location:
  • Phone: 724-381-1313
  • Fax:
Mailing address:
  • Phone: 812-217-4355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KEVIN VALVANO
Title or Position: OWNER
Credential: DO
Phone: 862-217-4355