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General NPI Number Information
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NPI Number | 1962888560
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Entity Type | Organization
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Legal Business Name | GENESIS SERVICES, LLC
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Dates
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Enumeration Date | 08/05/2015
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Last Update Date | 06/23/2016
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Provider Practice Location Address
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Address Line | 7407 88TH ST
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City | GLENDALE
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State | NY
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Zip | 11385-7951
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Country | US
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Telephone | 646-931-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 7407 88TH ST
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City | GLENDALE
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State | NY
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Zip | 11385-7951
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Country | US
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Telephone | 646-931-1000
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | NATHAN BRACHFELD
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Credential |
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Telephone | 800-975-5201
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment 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 | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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License Number | 7003284R
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License Number State | NY
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