Provider Demographics
NPI:1619265667
Name:GENAO, MAYRELI (DME SPECIALIST)
Entity Type:Individual
Prefix:
First Name:MAYRELI
Middle Name:
Last Name:GENAO
Suffix:
Gender:F
Credentials:DME SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:471 NEW BRUNSWICK AVE
Mailing Address - Street 2:
Mailing Address - City:PERTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08861-3646
Mailing Address - Country:US
Mailing Address - Phone:732-324-8700
Mailing Address - Fax:732-324-8702
Practice Address - Street 1:471 NEW BRUNSWICK AVE
Practice Address - Street 2:
Practice Address - City:PERTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08861-3646
Practice Address - Country:US
Practice Address - Phone:732-324-8700
Practice Address - Fax:732-324-8702
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-12
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ452712884332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ452712884OtherTAX ID