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General NPI Number Information
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NPI Number | 1003343435
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Entity Type | Organization
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Legal Business Name | NEW GENESIS
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Dates
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Enumeration Date | 05/16/2017
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 3485 E TREMONT AVE FL 2
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City | BRONX
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State | NY
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Zip | 10465-2016
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Country | US
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Telephone | 718-828-1549
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Fax | 516-303-0968
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Provider Business Mailing Address
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Address Line | 11728 225TH ST
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City | CAMBRIA HTS
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State | NY
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Zip | 11411-1706
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Country | US
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Telephone | 347-623-1163
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Fax | 516-303-0968
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JAMES LYNCH
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Credential | ESQ.
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Telephone | 347-623-1163
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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