Provider Demographics
NPI:1144658337
Name:EMANUELE, WILLIAM ANTHONY (DO)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ANTHONY
Last Name:EMANUELE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 191
Mailing Address - Street 2:PROVIDER ENROLLMENT
Mailing Address - City:ROCKLAND
Mailing Address - State:DE
Mailing Address - Zip Code:19732-0191
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:302-651-4945
Practice Address - Street 1:1280 ALMONESSON ROAD
Practice Address - Street 2:
Practice Address - City:DEPTFORD
Practice Address - State:NJ
Practice Address - Zip Code:08096-5502
Practice Address - Country:US
Practice Address - Phone:856-537-7060
Practice Address - Fax:856-805-9370
Is Sole Proprietor?:No
Enumeration Date:2013-10-24
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB09875400207XX0005X, 208000000X
DEC20011742208000000X
PAOS016839208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103258115Medicaid
MD1159984-00Medicaid