Healthcare Provider Details

I. General information

NPI: 1497836241
Provider Name (Legal Business Name): RONALD EMANUEL GENNACE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 BELLEVILLE TPKE SUITE 2A
NORTH ARLINGTON NJ
07031-6463
US

IV. Provider business mailing address

312 BELLEVILLE TPKE SUITE 2A
NORTH ARLINGTON NJ
07031-6463
US

V. Phone/Fax

Practice location:
  • Phone: 201-997-8777
  • Fax: 201-997-5957
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 StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: