Healthcare Provider Details

I. General information

NPI: 1427340595
Provider Name (Legal Business Name): RONALD E. GENNACE M,.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2011
Last Update Date: 05/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 BELLEVILLE TPK SUITE 2A
NO. ARLINGTON NJ
07031-6460
US

IV. Provider business mailing address

312 BELLEVILLE TPK STE 2A
NO. ARLINGTON NJ
07031-6460
US

V. Phone/Fax

Practice location:
  • Phone: 201-997-8777
  • Fax:
Mailing address:
  • Phone: 201-997-8777
  • Fax: 201-997-5957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number25MA03331000
License Number State

VIII. Authorized Official

Name: DR. RONALD E GENNACE
Title or Position: DOCTOR
Credential:
Phone: 201-997-8777