Provider Demographics
NPI:1417999020
Name:GENDY, GEORGE (PT)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:GENDY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 LONGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-3849
Mailing Address - Country:US
Mailing Address - Phone:732-385-1522
Mailing Address - Fax:
Practice Address - Street 1:888 EASTON AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-1898
Practice Address - Country:US
Practice Address - Phone:732-846-9400
Practice Address - Fax:732-846-9404
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01023000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ065649TPLMedicare ID - Type Unspecified