Provider Demographics
NPI:1215973508
Name:GENOVESE, MICHAEL RAYMOND (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:RAYMOND
Last Name:GENOVESE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:799 DEER PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11703-3812
Mailing Address - Country:US
Mailing Address - Phone:631-587-0872
Mailing Address - Fax:631-587-0855
Practice Address - Street 1:799 DEER PARK AVE
Practice Address - Street 2:
Practice Address - City:NORTH BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11703-3812
Practice Address - Country:US
Practice Address - Phone:631-587-0872
Practice Address - Fax:631-587-0855
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX006487-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX47451Medicare PIN