MEDICARE: MORDECHAI GENUT

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	171100000X	Acupuncturist

General Provider Information

NPI Number	:	1720695067
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MORDECHAI GENUT

Provider Business Mailing Address
First Line	:	133 POMONA RD
Second Line	:
City	:	POMONA
State	:	NY
Zip	:	10970-3526
Country	:	US
Telephone Number	:	718-801-6882
Fax Number	:

Provider Business Practice Location Address
First Line	:	125 S MAIN ST
Second Line	:
City	:	NEW CITY
State	:	NY
Zip	:	10956-3501
Country	:	US
Telephone Number	:	718-801-6882
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MORDECHAI GENUT
Credential	:	L.AC.
Telephone Number	:	718-801-6882

Provider Enumeration Date	:	09/30/2020
Last Update Date	:	09/30/2020

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Directions to “MORDECHAI GENUT ” Practice Location

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