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General NPI Number Information
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NPI Number | 1598056129
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Entity Type | Organization
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Legal Business Name | GENESIS MEDICAL DIAGNOSTICS, P.C.
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Dates
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Enumeration Date | 04/30/2011
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Last Update Date | 04/30/2011
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Provider Practice Location Address
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Address Line | 164 E 61ST ST #1A
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City | NEW YORK
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State | NY
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Zip | 10065-8539
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Country | US
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Telephone | 212-644-9100
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Fax | 212-644-6116
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Provider Business Mailing Address
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Address Line | 164 E 61ST ST #1A
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City | NEW YORK
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State | NY
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Zip | 10065-8539
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Country | US
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Telephone | 212-644-9100
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Fax | 212-644-6116
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Authorized Official
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Title or Position | OWNER
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Name | DR. RUTH CHAMBI JOHNSON
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Credential | M.D.
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Telephone | 347-756-1696
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 244276
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License Number State | NY
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