Provider Demographics
NPI:1578582292
Name:GENOVESI, MARK H (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:H
Last Name:GENOVESI
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1439 ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:NY
Mailing Address - Zip Code:10803-3607
Mailing Address - Country:US
Mailing Address - Phone:914-235-4004
Mailing Address - Fax:718-748-5539
Practice Address - Street 1:8318 4TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-4413
Practice Address - Country:US
Practice Address - Phone:718-748-0500
Practice Address - Fax:718-748-5539
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2021-08-06
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Provider Licenses
StateLicense IDTaxonomies
NY181571208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY209923853OtherTAX ID