Healthcare Provider Details

I. General information

NPI: 1295022978
Provider Name (Legal Business Name): GENESIS HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2011
Last Update Date: 12/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 MADISON AVE 2ND FLOOR
NEW YORK NY
10016-5421
US

IV. Provider business mailing address

206 E 17TH ST APT 5C
NEW YORK NY
10003-3636
US

V. Phone/Fax

Practice location:
  • Phone: 212-683-8905
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number021023
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number7941
License Number StateMA

VIII. Authorized Official

Name: MS. ALICIA WANG
Title or Position: SPEEH LANGUAGE PATHOLOGIST
Credential: MS-CCC/SLP
Phone: 617-663-7023