Provider Demographics
NPI:1528137262
Name:DEGENNARO, ANTHONY (MD FACS)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:
Last Name:DEGENNARO
Suffix:
Gender:M
Credentials:MD FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 STATE HIGHWAY 35
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701
Mailing Address - Country:US
Mailing Address - Phone:732-530-7799
Mailing Address - Fax:732-530-9091
Practice Address - Street 1:370 STATE HIGHWAY 35
Practice Address - Street 2:SUITE 100
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701
Practice Address - Country:US
Practice Address - Phone:732-530-7799
Practice Address - Fax:732-530-9091
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ51666207YX0007X
NY161571-1207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
A60872Medicare UPIN
NJ536613Medicare ID - Type Unspecified