Individual
DR. DOMENICK J SPORTELLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
25 POCONO RD, DENVILLE, NJ 07834
(973) 625-6000
Mailing address
1 PHEASANT RUN, BOONTON TOWNSHIP, NJ 07005-9036
(973) 868-8328
(973) 396-2575
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
25MB09258000
NJ
Other
Enumeration date
07/12/2010
Last updated
07/24/2018
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