Provider Demographics
NPI:1063690865
Name:MICHAEL V. GENOVESE, M.D., PLLC
Entity type:Organization
Organization Name:MICHAEL V. GENOVESE, M.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIARTY
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:V
Authorized Official - Last Name:GENOVESE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-747-1470
Mailing Address - Street 1:520 FRANKLIN AVE
Mailing Address - Street 2:SUITE L22
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-5806
Mailing Address - Country:US
Mailing Address - Phone:516-747-1470
Mailing Address - Fax:516-747-1485
Practice Address - Street 1:520 FRANKLIN AVE
Practice Address - Street 2:SUITE L22
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-5806
Practice Address - Country:US
Practice Address - Phone:516-747-1470
Practice Address - Fax:516-747-1485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-04
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2366382084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH88543Medicare UPIN
NY550BY1Medicare PIN