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Organization

GENESIS THERAPEUTICS INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. SHAKESPEARE NGO PHYSICAL THERAPIST (PRESIDENT)
(917) 724-1018
Entity
Organization

Contact information

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

Taxonomy

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

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
017925-1
NYS PT LICENSE NUMBER
NY
01
395780
NYS EI DOH ID NUMBER
NY
Enumeration date
01/09/2018
Last updated
06/16/2018
About Stedi
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