Provider Demographics
NPI:1629544051
Name:GENO, GRACE (PA)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:GENO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4811 BUCKLEY RD
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-3629
Mailing Address - Country:US
Mailing Address - Phone:315-457-9966
Mailing Address - Fax:315-457-9854
Practice Address - Street 1:4811 BUCKLEY RD
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-3629
Practice Address - Country:US
Practice Address - Phone:315-457-9966
Practice Address - Fax:315-457-9854
Is Sole Proprietor?:No
Enumeration Date:2018-10-24
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY022829OtherNYS DEPT OF ED