Provider Demographics
NPI:1407213267
Name:GENESIS
Entity type:Organization
Organization Name:GENESIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTIN
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:FINGERLIN
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:732-269-9335
Mailing Address - Street 1:20 PELICAN DR
Mailing Address - Street 2:
Mailing Address - City:BAYVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08721-1605
Mailing Address - Country:US
Mailing Address - Phone:732-269-9335
Mailing Address - Fax:
Practice Address - Street 1:20 PELICAN DR
Practice Address - Street 2:
Practice Address - City:BAYVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08721-1605
Practice Address - Country:US
Practice Address - Phone:732-269-9335
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-25
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJOTR46TR00503400310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility