Provider Demographics
NPI:1063415537
Name:GENIS, ILONA (MD)
Entity type:Individual
Prefix:MRS
First Name:ILONA
Middle Name:
Last Name:GENIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2965 OCEAN PKWY
Mailing Address - Street 2:STE 4
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-8024
Mailing Address - Country:US
Mailing Address - Phone:718-333-2020
Mailing Address - Fax:718-333-0743
Practice Address - Street 1:2965 OCEAN PKWY
Practice Address - Street 2:STE 4
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-8024
Practice Address - Country:US
Practice Address - Phone:718-333-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY187359207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01536910Medicaid
NY01536910Medicaid
NY01K961Medicare ID - Type Unspecified