Provider Demographics
NPI:1831544790
Name:ENRICO, ANTHONY J III
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:J
Last Name:ENRICO
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 RUTHERFORD BLVD
Mailing Address - Street 2:FLOOR 2
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07014-1219
Mailing Address - Country:US
Mailing Address - Phone:201-300-7575
Mailing Address - Fax:
Practice Address - Street 1:310 RUTHERFORD BLVD
Practice Address - Street 2:FLOOR 2
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07014-1219
Practice Address - Country:US
Practice Address - Phone:201-300-7575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-28
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies