# GENESIS CHIROPRACTIC PAIN MANAGEMENT P.C.

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

## Provider details

- **NPI number:** 1629360805
- **Authorized official:** DR. MAZAL JENNIFER SUYNOV D.C. (OWNER)
- **Authorized official phone:** (646) 581-2541

## Contact information

- **Practice address:** 164 EAST PENN STREET, LONG BEACH, NY 11561
- **Practice address phone:** (646) 581-2541
- **Practice address fax:** (718) 301-1804
- **Mailing address:** PO BOX 703, LONG BEACH, NY 11561-0703
- **Mailing address phone:** (646) 581-2541

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111N00000X | Chiropractor | X011936 | NY | Yes |

## Other

- **Enumeration date:** 05/06/2011
- **Last updated:** 12/19/2012