Healthcare Provider Details

I. General information

NPI: 1760094981
Provider Name (Legal Business Name): MRS. GENISE ACEVEDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2020
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11247 QUEENS BLVD STE 106
FOREST HILLS NY
11375-7420
US

IV. Provider business mailing address

10134 104TH ST
OZONE PARK NY
11416-2677
US

V. Phone/Fax

Practice location:
  • Phone: 347-391-4250
  • Fax: 347-391-0725
Mailing address:
  • Phone: 917-618-8815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number102858-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: