Healthcare Provider Details

I. General information

NPI: 1609447630
Provider Name (Legal Business Name): GENESIS FERTILITY AND REPRODUCTIVE MEDICINE, P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2021
Last Update Date: 03/02/2022
Certification Date: 02/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6010 BAY PKWY STE 501
BROOKLYN NY
11204-6080
US

IV. Provider business mailing address

6010 BAY PKWY STE 501
BROOKLYN NY
11204-6080
US

V. Phone/Fax

Practice location:
  • Phone: 718-513-4021
  • Fax: 718-283-6580
Mailing address:
  • Phone: 718-513-4021
  • Fax: 718-283-6580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QA0006X
TaxonomyAmbulatory Fertility Facility
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD V GRAZI
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 718-513-4021