Provider Demographics
NPI:1124113691
Name:DE GENNARO, MARIANNE ELIZABETH (DO)
Entity type:Individual
Prefix:DR
First Name:MARIANNE
Middle Name:ELIZABETH
Last Name:DE GENNARO
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:370 HWY 35
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-5922
Mailing Address - Country:US
Mailing Address - Phone:732-530-5437
Mailing Address - Fax:732-219-5437
Practice Address - Street 1:370 HWY 35
Practice Address - Street 2:SUITE 200
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-5922
Practice Address - Country:US
Practice Address - Phone:732-530-5437
Practice Address - Fax:732-219-5437
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2010-07-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY179827208000000X
NJ25MB06729500208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF69296Medicare UPIN