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General NPI Number Information
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NPI Number | 1215462635
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Entity Type | Organization
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Legal Business Name | DENNIS COLLABORATIVE CARE LLC
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Dates
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Enumeration Date | 04/23/2017
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Last Update Date | 06/21/2017
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Provider Practice Location Address
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Address Line | 17 CASINO DR
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City | FARMINGDALE
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State | NJ
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Zip | 07727-3701
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Country | US
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Telephone | 732-255-2252
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Fax | 848-444-8001
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Provider Business Mailing Address
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Address Line | PO BOX 303
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City | ALLENHURST
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State | NJ
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Zip | 07711-0303
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Country | US
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Telephone | 732-255-2252
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Fax | 848-444-8001
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Authorized Official
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Title or Position | PRESIDENT/REGISTERED AGENT
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Name | DR. PHILP DENNIS
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Credential | MD
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Telephone | 732-255-2252
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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