Provider Demographics
NPI:1164450136
Name:GENOVESE, LEONARD DANIEL JR (DO)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:DANIEL
Last Name:GENOVESE
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1310 84TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-3000
Mailing Address - Country:US
Mailing Address - Phone:718-837-5685
Mailing Address - Fax:718-837-0130
Practice Address - Street 1:1310 84TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-3000
Practice Address - Country:US
Practice Address - Phone:718-837-5685
Practice Address - Fax:718-837-0130
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY197631207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1P1272OtherHEALTHNET
NY5902016OtherGHI
NY13194OtherELDERPLAN
NYP458055OtherOXFORD
NY1400594OtherUNITED HEALTHCARE
NY4661531OtherAETNA
NY8274288OtherCIGNA
NY01652088Medicaid
NY25U121OtherEMPIRE BC BS
NY13194OtherELDERPLAN
NY8274288OtherCIGNA