Healthcare Provider Details

I. General information

NPI: 1770041253
Provider Name (Legal Business Name): ALAN M GENITEMPO L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2019
Last Update Date: 03/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 WASHINGTON AVE
NUTLEY NJ
07110-1997
US

IV. Provider business mailing address

208 BLOOMFIELD AVE APT 204
BLOOMFIELD NJ
07003-5795
US

V. Phone/Fax

Practice location:
  • Phone: 973-868-7001
  • Fax:
Mailing address:
  • Phone: 973-868-7001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number25MZ00136700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: