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General NPI Number Information
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NPI Number | 1750257937
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Entity Type | Organization
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Legal Business Name | GENESIS A CLINIC INC
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Dates
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Enumeration Date | 10/14/2025
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Last Update Date | 10/14/2025
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Provider Practice Location Address
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Address Line | 442 BROADWAY
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City | CAMDEN
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State | NJ
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Zip | 08103-1246
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Country | US
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Telephone | 646-730-0249
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Fax |
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Provider Business Mailing Address
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Address Line | 442 BROADWAY
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City | CAMDEN
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State | NJ
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Zip | 08103-1246
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Country | US
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Telephone | 646-730-0249
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | EVELYN AWUNDAGA
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Credential |
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Telephone | 646-730-0249
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0208X
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Taxonomy Name | Mobile Radiology Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QS1000X
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Taxonomy Name | Student Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QC1800X
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Taxonomy Name | Corporate Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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