Provider Demographics
NPI:1770041253
Name:GENITEMPO, ALAN M (LAC)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:M
Last Name:GENITEMPO
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 BLOOMFIELD AVE APT 204
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-5795
Mailing Address - Country:US
Mailing Address - Phone:973-868-7001
Mailing Address - Fax:
Practice Address - Street 1:259 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-1997
Practice Address - Country:US
Practice Address - Phone:973-868-7001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-04
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00136700171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist