Healthcare Provider Details

I. General information

NPI: 1891813259
Provider Name (Legal Business Name): EDWARD A. GENOVESI D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6932 TORRESDALE AVE
PHILADELPHIA PA
19135-1906
US

IV. Provider business mailing address

6932 TORRESDALE AVE
PHILADELPHIA PA
19135-1906
US

V. Phone/Fax

Practice location:
  • Phone: 215-338-8840
  • Fax: 215-338-8841
Mailing address:
  • Phone: 215-338-8840
  • Fax: 215-338-8841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberDC007523L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: