Provider Demographics
NPI:1083829154
Name:GENESIS FAMILY CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:GENESIS FAMILY CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FEODOR
Authorized Official - Middle Name:A
Authorized Official - Last Name:SAKATCH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:201-941-8008
Mailing Address - Street 1:596 ANDERSON AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CLIFFSIDE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07010-1831
Mailing Address - Country:US
Mailing Address - Phone:201-941-8008
Mailing Address - Fax:201-941-3880
Practice Address - Street 1:596 ANDERSON AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:CLIFFSIDE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07010-1831
Practice Address - Country:US
Practice Address - Phone:201-941-8008
Practice Address - Fax:201-941-3880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00615800111NR0400X
NJ40QA01156300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ090176Medicare ID - Type Unspecified
NJV04705Medicare UPIN