Provider Demographics
NPI:1821104993
Name:GENATO, ROMULO L (MD)
Entity Type:Individual
Prefix:DR
First Name:ROMULO
Middle Name:L
Last Name:GENATO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:55 INDEPENDENCE CT
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-3840
Mailing Address - Country:US
Mailing Address - Phone:973-777-0926
Mailing Address - Fax:973-777-6052
Practice Address - Street 1:121 DEKALB AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5425
Practice Address - Country:US
Practice Address - Phone:718-250-6920
Practice Address - Fax:718-250-6080
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY134172208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00349257Medicaid
NYCO4543Medicare UPIN
NYO2A651Medicare ID - Type Unspecified