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General NPI Number Information
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NPI Number | 1134625924
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Entity Type | Individual
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Provider Name | ABIGAIL GENCO
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Gender | Female
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Dates
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Enumeration Date | 04/02/2018
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Last Update Date | 07/20/2021
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Provider Practice Location Address
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Address Line | 3430 BURNET AVE
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City | CINCINNATI
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State | OH
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Zip | 45229-2833
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Country | US
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Telephone | 614-325-2214
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Fax |
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Provider Business Mailing Address
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Address Line | 4616 LARGO DR
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City | CINCINNATI
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State | OH
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Zip | 45236-3212
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Country | US
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Telephone | 614-325-2214
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 125.072651
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 2080P0006X
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Taxonomy Name | Developmental - Behavioral Pediatrics Physician
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License Number | 35141895
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License Number State | OH
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