Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YX0007X | Plastic Surgeon (Head & Neck) | 161571-1 | NY |
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | 51666 | NJ |
NPI | 1528137262 |
---|---|
Provider Name | Dr. Anthony Degennaro |
First Address | Red Bank, NJ 07701 |
Second Address | Red Bank, NJ 07701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A60872 | (02) |