Provider Demographics
NPI:1851797583
Name:GENDY, ALFRED SR
Entity Type:Individual
Prefix:
First Name:ALFRED
Middle Name:
Last Name:GENDY
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6270 60TH PL
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-2028
Mailing Address - Country:US
Mailing Address - Phone:347-985-6197
Mailing Address - Fax:
Practice Address - Street 1:6270 60TH PL
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-2028
Practice Address - Country:US
Practice Address - Phone:347-985-6197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-06
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00309200225200000X
CT001395225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant