Provider Demographics
NPI:1255432688
Name:GONNELLA, ELEANOR A (MD)
Entity type:Individual
Prefix:DR
First Name:ELEANOR
Middle Name:A
Last Name:GONNELLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:47 ORIENT WAY
Mailing Address - Street 2:SUITE 3B
Mailing Address - City:RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07070
Mailing Address - Country:US
Mailing Address - Phone:201-939-2826
Mailing Address - Fax:201-939-0562
Practice Address - Street 1:47 ORIENT WAY
Practice Address - Street 2:SUITE 3B
Practice Address - City:RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07070
Practice Address - Country:US
Practice Address - Phone:201-939-2826
Practice Address - Fax:201-939-0562
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA04298900207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F09809Medicare UPIN
NJF09809Medicare UPIN
053325Medicare ID - Type Unspecified