Provider Demographics
NPI:1043499825
Name:MICHAEL J DENNER MD PA
Entity type:Organization
Organization Name:MICHAEL J DENNER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LUCY
Authorized Official - Middle Name:A
Authorized Official - Last Name:AZZARANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-853-1133
Mailing Address - Street 1:17 W RED BANK AVE
Mailing Address - Street 2:STE 204
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096
Mailing Address - Country:US
Mailing Address - Phone:856-853-1133
Mailing Address - Fax:856-845-5405
Practice Address - Street 1:17 W RED BANK AVE
Practice Address - Street 2:STE 204
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096
Practice Address - Country:US
Practice Address - Phone:856-853-1133
Practice Address - Fax:856-845-5405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA417862084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3229505Medicaid
NJE58667Medicare UPIN
NJ671759Medicare Oscar/Certification