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General NPI Number Information
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NPI Number | 1437666765
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Entity Type | Organization
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Legal Business Name | GENESIS THERAPEUTICS INC
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Dates
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Enumeration Date | 01/09/2018
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 6402 DEWEY AVE APT 13
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City | WEST NEW YORK
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State | NJ
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Zip | 07093-3090
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Country | US
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Telephone | 917-724-1018
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Fax |
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Provider Business Mailing Address
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Address Line | 6402 DEWEY AVE APT 13
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City | WEST NEW YORK
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State | NJ
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Zip | 07093-3090
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Country | US
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Telephone | 917-724-1018
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. SHAKESPEARE NGO
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Credential | PHYSICAL THERAPIST
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Telephone | 917-724-1018
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 0008162
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 01578F
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License Number State | LA
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5004
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License Number State | NC
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Taxonomy #4
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 017925-1
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License Number State | NY
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