Provider Demographics
NPI:1235945890
Name:GENECKI, ANGELA (RDN)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:GENECKI
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 STONE HILL RD APT G12
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-2146
Mailing Address - Country:US
Mailing Address - Phone:908-451-7092
Mailing Address - Fax:
Practice Address - Street 1:100 STONE HILL RD APT G12
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-2146
Practice Address - Country:US
Practice Address - Phone:908-451-7092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X
NJ86050514133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered