Provider Demographics
NPI:1578568846
Name:GENNA, CAROLYN M (AUD, FAAA)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:M
Last Name:GENNA
Suffix:
Gender:F
Credentials:AUD, FAAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 HILLSIDE AVE
Mailing Address - Street 2:STE 99H
Mailing Address - City:WILLISTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11596-2333
Mailing Address - Country:US
Mailing Address - Phone:516-873-9742
Mailing Address - Fax:516-873-9861
Practice Address - Street 1:99 HILLSIDE AVE
Practice Address - Street 2:STE 99H
Practice Address - City:WILLISTON PARK
Practice Address - State:NY
Practice Address - Zip Code:11596-2333
Practice Address - Country:US
Practice Address - Phone:516-873-9742
Practice Address - Fax:516-873-9861
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001105231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY113327198OtherTAXID/PROV# FOR HMO'S
NY01749724Medicaid
NY113327198OtherTAXID/PROV# FOR HMO'S