Provider Demographics
NPI:1013095975
Name:ENRICO, ANTHONY J (DPM)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:J
Last Name:ENRICO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07514-1918
Mailing Address - Country:US
Mailing Address - Phone:973-278-8001
Mailing Address - Fax:973-742-6793
Practice Address - Street 1:628 BROADWAY
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07514-1918
Practice Address - Country:US
Practice Address - Phone:973-278-8001
Practice Address - Fax:973-742-6793
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00172300213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJT45989Medicare UPIN