Healthcare Provider Details

I. General information

NPI: 1013221308
Provider Name (Legal Business Name): LALAINE GENUINO APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2010
Last Update Date: 03/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 MAIN ST
TOMS RIVER NJ
08753-6699
US

IV. Provider business mailing address

3 CLARK CT
MONROE TOWNSHIP NJ
08831-4035
US

V. Phone/Fax

Practice location:
  • Phone: 732-557-0100
  • Fax: 732-557-0128
Mailing address:
  • Phone: 732-521-0078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ00296100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: