Provider Demographics
NPI:1609110857
Name:SHORE-GENACK, CARYN (MS OTR/L)
Entity Type:Individual
Prefix:
First Name:CARYN
Middle Name:
Last Name:SHORE-GENACK
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 EDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07012-1517
Mailing Address - Country:US
Mailing Address - Phone:917-338-6025
Mailing Address - Fax:
Practice Address - Street 1:1373 BROAD ST
Practice Address - Street 2:SUITE 302
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-4200
Practice Address - Country:US
Practice Address - Phone:973-773-4263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-11
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00582800225X00000X
NY0174861225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist