Provider Demographics
NPI:1215462635
Name:DENNIS COLLABORATIVE CARE LLC
Entity type:Organization
Organization Name:DENNIS COLLABORATIVE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/REGISTERED AGENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILP
Authorized Official - Middle Name:
Authorized Official - Last Name:DENNIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-255-2252
Mailing Address - Street 1:PO BOX 303
Mailing Address - Street 2:
Mailing Address - City:ALLENHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07711-0303
Mailing Address - Country:US
Mailing Address - Phone:732-255-2252
Mailing Address - Fax:848-444-8001
Practice Address - Street 1:17 CASINO DR
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NJ
Practice Address - Zip Code:07727-3701
Practice Address - Country:US
Practice Address - Phone:732-255-2252
Practice Address - Fax:848-444-8001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-23
Last Update Date:2017-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty