Provider Demographics
NPI:1427703412
Name:GENERATIONAL HEALTH BY ADULT HEALTH NP, P.C
Entity type:Organization
Organization Name:GENERATIONAL HEALTH BY ADULT HEALTH NP, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PENDOR
Authorized Official - Middle Name:
Authorized Official - Last Name:HAIYEDE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:646-584-0156
Mailing Address - Street 1:116 SUMPTER ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11233-2344
Mailing Address - Country:US
Mailing Address - Phone:646-584-0156
Mailing Address - Fax:
Practice Address - Street 1:116 SUMPTER ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11233-2344
Practice Address - Country:US
Practice Address - Phone:646-584-0156
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-17
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center