Provider Demographics
NPI:1215948344
Name:GENAU, YOUNG J (MD)
Entity type:Individual
Prefix:
First Name:YOUNG
Middle Name:J
Last Name:GENAU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:YOUNG
Other - Middle Name:J
Other - Last Name:GENAU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:301 LIPPINCOTT DR STE 410
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4197
Mailing Address - Country:US
Mailing Address - Phone:856-355-0340
Mailing Address - Fax:856-355-0330
Practice Address - Street 1:7131-39 FRANKFORD AVENUE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19135
Practice Address - Country:US
Practice Address - Phone:215-332-4164
Practice Address - Fax:215-332-9638
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA05729207Q00000X
PAMD455524207Q00000X
NJ26NR09087900367500000X
NJ25MA09612300208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARES000Medicare UPIN
GARES000Medicare Oscar/Certification
GARES000Medicaid
GARES000Medicare PIN