Provider Demographics
NPI:1609088699
Name:GENUALDI ORTHODONTIC ASSOCIATES, PA
Entity Type:Organization
Organization Name:GENUALDI ORTHODONTIC ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GENUALDI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:908-273-7450
Mailing Address - Street 1:52 DEFOREST AVE
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-1930
Mailing Address - Country:US
Mailing Address - Phone:908-273-7450
Mailing Address - Fax:908-273-7633
Practice Address - Street 1:52 DEFOREST AVE
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-1930
Practice Address - Country:US
Practice Address - Phone:908-273-7450
Practice Address - Fax:908-273-7633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty