Provider Demographics
NPI:1124764113
Name:GENETICS AND METABOLISM LLC
Entity type:Organization
Organization Name:GENETICS AND METABOLISM LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:PERSZYK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-673-5895
Mailing Address - Street 1:112 BARTRAM OAKS WALK UNIT 600849
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32260-7734
Mailing Address - Country:US
Mailing Address - Phone:904-673-0044
Mailing Address - Fax:906-673-1064
Practice Address - Street 1:1110 A1A N STE 101
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-4071
Practice Address - Country:US
Practice Address - Phone:904-673-0044
Practice Address - Fax:904-673-1064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-11
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)Group - Single Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty