Provider Demographics
NPI:1932605201
Name:GENOVESE, NICHOLAS (MD)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:GENOVESE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 WARREN ST APT 426
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-2584
Mailing Address - Country:US
Mailing Address - Phone:908-239-6938
Mailing Address - Fax:
Practice Address - Street 1:755 MEMORIAL PKWY STE 201
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-2748
Practice Address - Country:US
Practice Address - Phone:908-847-8884
Practice Address - Fax:833-204-9604
Is Sole Proprietor?:No
Enumeration Date:2018-04-04
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD486372207X00000X
NJ25MA12348800207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA12348800OtherNJ MEDICAL LICENSE
PAMD486372OtherPA MEDICAL LICENSE