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General NPI Number Information
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NPI Number | 1528137262
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Entity Type | Individual
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Provider Name | ANTHONY DEGENNARO MD FACS
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Gender | Male
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Dates
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Enumeration Date | 11/07/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 370 STATE HIGHWAY 35 SUITE 100
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City | RED BANK
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State | NJ
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Zip | 07701
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Country | US
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Telephone | 732-530-7799
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Fax | 732-530-9091
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Provider Business Mailing Address
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Address Line | 370 STATE HIGHWAY 35 SUITE 100
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City | RED BANK
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State | NJ
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Zip | 07701
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Country | US
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Telephone | 732-530-7799
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Fax | 732-530-9091
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YX0007X
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Taxonomy Name | Plastic Surgery within the Head & Neck (Otolaryngology) Physician
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License Number | 51666
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207YX0007X
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Taxonomy Name | Plastic Surgery within the Head & Neck (Otolaryngology) Physician
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License Number | 161571-1
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License Number State | NY
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