# GENOA HEALTHCARE OF NEW JERSEY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Genoa Healthcare
- **Organization subpart:** No

## Provider details

- **NPI number:** 1376953778
- **Authorized official:** RYAN NIEMEYER (CONTROLLER)
- **Authorized official phone:** (253) 218-0830

## Contact information

- **Practice address:** 2550 BRUNSWICK PIKE, SUITE 1A, LAWRENCEVILLE, NJ 08648-4103
- **Practice address phone:** (253) 218-0830
- **Practice address fax:** (253) 217-4306
- **Mailing address:** PO BOX 77030, MINNEAPOLIS, MN 55480-7730
- **Mailing address phone:** (253) 218-0830
- **Mailing address fax:** (253) 217-4306

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 05/07/2014
- **Last updated:** 05/07/2014