Provider Demographics
NPI:1043027634
Name:GARDEN STATE SPORTS MEDICINE LLC
Entity type:Organization
Organization Name:GARDEN STATE SPORTS MEDICINE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:VALVANO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:862-217-4355
Mailing Address - Street 1:3799 US HIGHWAY 46 STE 110
Mailing Address - Street 2:
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054-1060
Mailing Address - Country:US
Mailing Address - Phone:812-217-4355
Mailing Address - Fax:
Practice Address - Street 1:3799 ROUTE 46 STE 110
Practice Address - Street 2:
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-1060
Practice Address - Country:US
Practice Address - Phone:724-381-1313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-17
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Single Specialty
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine