Provider Demographics
NPI:1336263680
Name:VENEZIA, ANNE M (NP)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:M
Last Name:VENEZIA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 N BEERS ST
Mailing Address - Street 2:SUITE 1-F
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-1518
Mailing Address - Country:US
Mailing Address - Phone:732-888-9100
Mailing Address - Fax:732-888-5515
Practice Address - Street 1:721 N BEERS ST
Practice Address - Street 2:SUITE 1-F
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1518
Practice Address - Country:US
Practice Address - Phone:732-888-9100
Practice Address - Fax:732-888-5515
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN06635300363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP55464Medicare UPIN
NJ056406C2LMedicare ID - Type Unspecified