MEDICARE: GENESIS IVDRIPS & WELLNESS LLC

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	251F00000X	Home Infusion Agency

General Provider Information

NPI Number	:	1750966206
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENESIS IVDRIPS & WELLNESS LLC

Provider Business Mailing Address
First Line	:	442 BROADWAY
Second Line	:
City	:	CAMDEN
State	:	NJ
Zip	:	08103-1246
Country	:	US
Telephone Number	:	856-246-1070
Fax Number	:

Provider Business Practice Location Address
First Line	:	442 BROADWAY
Second Line	:
City	:	CAMDEN
State	:	NJ
Zip	:	08103-1246
Country	:	US
Telephone Number	:	856-246-1070
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	EVELYN MANKAH AWUNDAGA
Credential	:
Telephone Number	:	856-246-1070

Provider Enumeration Date	:	03/16/2021
Last Update Date	:	05/04/2021

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