Provider Demographics
NPI:1609982602
Name:GENSON, CHRIS RONALD (PT)
Entity Type:Individual
Prefix:MR
First Name:CHRIS
Middle Name:RONALD
Last Name:GENSON
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 1:79 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401
Mailing Address - Country:US
Mailing Address - Phone:845-750-6123
Mailing Address - Fax:845-750-6436
Practice Address - Street 1:79 MAIN STREET
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-4901
Practice Address - Country:US
Practice Address - Phone:845-750-6123
Practice Address - Fax:845-750-6436
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025525-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q25V21Medicare ID - Type Unspecified