=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558453498
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALBERT ANDRE DENEVE MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/29/2006
-----------------------------------------------------
Last Update Date | 05/19/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 143 E RIDGEWOOD AVE UNIT 539
-----------------------------------------------------
City | RIDGEWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07451-7026
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-251-9030
-----------------------------------------------------
Fax | 201-251-9032
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 143 E RIDGEWOOD AVE UNIT 539
-----------------------------------------------------
City | RIDGEWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07451-7026
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-251-9030
-----------------------------------------------------
Fax | 201-251-9032
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RH0003X
-----------------------------------------------------
Taxonomy Name | Hematology & Oncology Physician
-----------------------------------------------------
License Number | 25MA04896500
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------