MEDICARE: GENESIS YOGA

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
1	374J00000X	Doula

General Provider Information

NPI Number	:	1619744661
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENESIS YOGA

Provider Business Mailing Address
First Line	:	1 BRUSH HILL RD # 342
Second Line	:
City	:	NEW FAIRFIELD
State	:	CT
Zip	:	06812-2667
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	47 WEST ST STE 7
Second Line	:
City	:	DANBURY
State	:	CT
Zip	:	06810-6517
Country	:	US
Telephone Number	:	203-402-8498
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DIANNA CARRASQUILLO
Credential	:
Telephone Number	:	203-402-8498

Provider Enumeration Date	:	12/11/2023
Last Update Date	:	12/11/2023

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Directions to “GENESIS YOGA ” Practice Location

Language	Start Address	Practice Location

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