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NPI Code Detail

MEDICARE: DR. MARK H GENOVESI M.D.

MEDICARE: DR. MARK H GENOVESI M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208600000XSurgery Physician181571NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1209923853OTHERNYTAX ID

General Provider Information

NPI Number : 1578582292
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARK H GENOVESI M.D.
Provider Business Mailing Address
First Line : 1439 ROOSEVELT AVE
Second Line :
City : PELHAM
State : NY
Zip : 10803-3607
Country : US
Telephone Number : 914-235-4004
Fax Number : 718-748-5539
Provider Business Practice Location Address
First Line : 8318 4TH AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11209-4413
Country : US
Telephone Number : 718-748-0500
Fax Number : 718-748-5539
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2006
Last Update Date : 08/06/2021

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