Provider Demographics
NPI:1003343435
Name:NEW GENESIS
Entity Type:Organization
Organization Name:NEW GENESIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:LYNCH
Authorized Official - Suffix:
Authorized Official - Credentials:ESQ
Authorized Official - Phone:347-623-1163
Mailing Address - Street 1:11728 225TH ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIA HTS
Mailing Address - State:NY
Mailing Address - Zip Code:11411-1706
Mailing Address - Country:US
Mailing Address - Phone:347-623-1163
Mailing Address - Fax:516-303-0968
Practice Address - Street 1:3485 E TREMONT AVE FL 2
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-2016
Practice Address - Country:US
Practice Address - Phone:718-828-1549
Practice Address - Fax:516-303-0968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-16
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center