Provider Demographics
NPI:1063866614
Name:GENESIS OBSTETRICS & GYNECOLOGY, P.C.
Entity Type:Organization
Organization Name:GENESIS OBSTETRICS & GYNECOLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANGLERO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:954-899-4763
Mailing Address - Street 1:PO BOX 518
Mailing Address - Street 2:
Mailing Address - City:MOYOCK
Mailing Address - State:NC
Mailing Address - Zip Code:27958-0518
Mailing Address - Country:US
Mailing Address - Phone:757-602-1099
Mailing Address - Fax:
Practice Address - Street 1:2925 AVENTURA BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-3124
Practice Address - Country:US
Practice Address - Phone:305-931-7424
Practice Address - Fax:305-931-7425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-20
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS13366207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty