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General NPI Number Information
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NPI Number | 1912065962
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Entity Type | Organization
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Legal Business Name | DML SPORTS MEDICINE, L.L.C
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Dates
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Enumeration Date | 12/04/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 96 MANNER AVE
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City | GARFIELD
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State | NJ
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Zip | 07026-1418
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Country | US
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Telephone | 973-722-0099
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 266
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City | WYCKOFF
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State | NJ
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Zip | 07481-0266
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Country | US
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Telephone | 201-390-3080
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHAEL LORETI
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Credential | M.D.
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Telephone | 201-390-3080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number |
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License Number State |
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