# GENESIS THERAPEUTICS INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1437666765
- **Authorized official:** MR. SHAKESPEARE NGO PHYSICAL THERAPIST (PRESIDENT)
- **Authorized official phone:** (917) 724-1018

## Contact information

- **Practice address:** 6402 DEWEY AVE APT 13, WEST NEW YORK, NJ 07093-3090
- **Practice address phone:** (917) 724-1018
- **Mailing address:** 6402 DEWEY AVE APT 13, WEST NEW YORK, NJ 07093-3090
- **Mailing address phone:** (917) 724-1018

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | 0008162 | FL | — |
| 225100000X | Physical Therapist | 01578F | LA | — |
| 225100000X | Physical Therapist | 017925-1 | NY | Yes |
| 225100000X | Physical Therapist | 5004 | NC | — |

## Other

- **Enumeration date:** 01/09/2018
- **Last updated:** 06/16/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 017925-1 | NYS PT LICENSE NUMBER | NY |
| 01 | — | 395780 | NYS EI DOH ID NUMBER | NY |