Provider Demographics
NPI:1487261277
Name:DI GENNARO, FLORENCE MARIE (MSOM, LAC)
Entity type:Individual
Prefix:
First Name:FLORENCE
Middle Name:MARIE
Last Name:DI GENNARO
Suffix:
Gender:F
Credentials:MSOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 GILL LN APT 5K
Mailing Address - Street 2:
Mailing Address - City:ISELIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08830-2820
Mailing Address - Country:US
Mailing Address - Phone:201-208-8483
Mailing Address - Fax:
Practice Address - Street 1:524 NORTHAMPTON ST
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-3517
Practice Address - Country:US
Practice Address - Phone:908-827-1826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-26
Last Update Date:2020-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOM000282171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist