Provider Demographics
NPI:1154345569
Name:GENOVESE, MICHAEL V (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:V
Last Name:GENOVESE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:520 FRANKLIN AVE
Mailing Address - Street 2:SUITE L3
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 L3
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2009-06-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY2366382084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH88543Medicare UPIN
NY550BY1Medicare ID - Type Unspecified