Provider Demographics
NPI:1427340595
Name:RONALD E. GENNACE M,.D., P.A.
Entity type:Organization
Organization Name:RONALD E. GENNACE M,.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:E
Authorized Official - Last Name:GENNACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-997-8777
Mailing Address - Street 1:312 BELLEVILLE TPK
Mailing Address - Street 2:STE 2A
Mailing Address - City:NO. ARLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07031-6460
Mailing Address - Country:US
Mailing Address - Phone:201-997-8777
Mailing Address - Fax:201-997-5957
Practice Address - Street 1:312 BELLEVILLE TPK
Practice Address - Street 2:SUITE 2A
Practice Address - City:NO. ARLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07031-6460
Practice Address - Country:US
Practice Address - Phone:201-997-8777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-09
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
25MA03331000207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC56311Medicare UPIN