Provider Demographics
NPI:1114067758
Name:GENCER, EKMEL (RPH)
Entity Type:Individual
Prefix:
First Name:EKMEL
Middle Name:
Last Name:GENCER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 HURD ST
Mailing Address - Street 2:
Mailing Address - City:MINE HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:07803
Mailing Address - Country:US
Mailing Address - Phone:973-537-0347
Mailing Address - Fax:
Practice Address - Street 1:5721 5TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-3853
Practice Address - Country:US
Practice Address - Phone:718-439-3500
Practice Address - Fax:718-439-5207
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044758183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01242039Medicaid
NY01242039Medicaid