Provider Demographics
NPI:1497836241
Name:GENNACE, RONALD EMANUEL (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:EMANUEL
Last Name:GENNACE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 BELLEVILLE TPKE
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:NORTH ARLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07031-6463
Mailing Address - Country:US
Mailing Address - Phone:201-997-8777
Mailing Address - Fax:201-997-5957
Practice Address - Street 1:312 BELLEVILLE TPKE
Practice Address - Street 2:SUITE 2A
Practice Address - City:NORTH ARLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07031-6463
Practice Address - Country:US
Practice Address - Phone:201-997-8777
Practice Address - Fax:201-997-5957
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03331000207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ461759Medicare ID - Type Unspecified
NJC56311Medicare UPIN