Provider Demographics
NPI:1013221308
Name:GENUINO, LALAINE (APN)
Entity Type:Individual
Prefix:MRS
First Name:LALAINE
Middle Name:
Last Name:GENUINO
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 CLARK CT
Mailing Address - Street 2:
Mailing Address - City:MONROE TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-4035
Mailing Address - Country:US
Mailing Address - Phone:732-521-0078
Mailing Address - Fax:
Practice Address - Street 1:803 MAIN ST
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-6699
Practice Address - Country:US
Practice Address - Phone:732-557-0100
Practice Address - Fax:732-557-0128
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-29
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00296100363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP01140704OtherRAILROAD MEDICARE
NJ0238121Medicaid
NJP01140704OtherRAILROAD MEDICARE