=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992981955
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARIO N GENOVESE DPM, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/21/2008
-----------------------------------------------------
Last Update Date | 05/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9602 4TH AVE APT. L1
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11209-3439
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-748-7474
-----------------------------------------------------
Fax | 718-748-7474
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7715 4TH AVE
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11209-3439
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-748-7474
-----------------------------------------------------
Fax | 718-748-7474
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. MARIO N GENOVESE
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 718-748-7474
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | N004091
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------