Provider Demographics
NPI:1790002111
Name:FINNEGAN, GENET M (MHS, RPA-C)
Entity Type:Individual
Prefix:MS
First Name:GENET
Middle Name:M
Last Name:FINNEGAN
Suffix:
Gender:F
Credentials:MHS, RPA-C
Other - Prefix:MS
Other - First Name:GENET
Other - Middle Name:M
Other - Last Name:DEFAZIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MHS-RPA-C
Mailing Address - Street 1:166 5TH AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-5909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:166 5TH AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-5909
Practice Address - Country:US
Practice Address - Phone:212-229-0333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-25
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013643-1363A00000X
NJ25MP00228900363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant