Provider Demographics
NPI:1902030331
Name:DE GENOVA, ERNESTO (MS SLP-CCC)
Entity Type:Individual
Prefix:
First Name:ERNESTO
Middle Name:
Last Name:DE GENOVA
Suffix:
Gender:M
Credentials:MS SLP-CCC
Other - Prefix:
Other - First Name:ERNESTO
Other - Middle Name:
Other - Last Name:DE GENOVA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS
Mailing Address - Street 1:208 CENTRE AVE APT 5C
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10805-2623
Mailing Address - Country:US
Mailing Address - Phone:917-549-8874
Mailing Address - Fax:
Practice Address - Street 1:208 CENTRE AVE APT 5C
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10805-2623
Practice Address - Country:US
Practice Address - Phone:917-549-8874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-13
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018488-1235Z00000X
NY018488235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist