Provider Demographics
NPI:1225569858
Name:GENIUS THERAPY LLC
Entity Type:Organization
Organization Name:GENIUS THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:
Authorized Official - Last Name:GULYAKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-372-3520
Mailing Address - Street 1:35 SEACOAST TER
Mailing Address - Street 2:APT 10L
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-6040
Mailing Address - Country:US
Mailing Address - Phone:347-372-3520
Mailing Address - Fax:
Practice Address - Street 1:35 SEACOAST TER
Practice Address - Street 2:APT 10L
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-6040
Practice Address - Country:US
Practice Address - Phone:347-372-3520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-24
Last Update Date:2017-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No251B00000XAgenciesCase Management