Provider Demographics
NPI:1962888560
Name:GENESIS SERVICES, LLC
Entity type:Organization
Organization Name:GENESIS SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRACHFELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-975-5201
Mailing Address - Street 1:7407 88TH ST
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385-7951
Mailing Address - Country:US
Mailing Address - Phone:646-931-1000
Mailing Address - Fax:
Practice Address - Street 1:7407 88TH ST
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:NY
Practice Address - Zip Code:11385-7951
Practice Address - Country:US
Practice Address - Phone:646-931-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-05
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QE0700X
NY7003284R261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY332734Medicare Oscar/Certification