Provider Demographics
NPI:1609211382
Name:GENCARELLI, ANTHONY (DC)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:
Last Name:GENCARELLI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11004
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07004-7004
Mailing Address - Country:US
Mailing Address - Phone:973-200-0170
Mailing Address - Fax:
Practice Address - Street 1:18 FURLER ST
Practice Address - Street 2:
Practice Address - City:TOTOWA
Practice Address - State:NJ
Practice Address - Zip Code:07512-2765
Practice Address - Country:US
Practice Address - Phone:973-200-0170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-08
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC005772111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor