Healthcare Provider Details

I. General information

NPI: 1851573877
Provider Name (Legal Business Name): JO-ANN M. GENESTE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2007
Last Update Date: 02/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 30TH AVE
ASTORIA NY
11102-2448
US

IV. Provider business mailing address

2510 30TH AVE
ASTORIA NY
11102-2448
US

V. Phone/Fax

Practice location:
  • Phone: 718-932-1000
  • Fax:
Mailing address:
  • Phone: 718-932-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number012153
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: