Provider Demographics
NPI:1942768858
Name:DALESSANDRO, GENARO
Entity Type:Individual
Prefix:
First Name:GENARO
Middle Name:
Last Name:DALESSANDRO
Suffix:
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 1:1948 DURFOR ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19145-3611
Mailing Address - Country:US
Mailing Address - Phone:215-755-0895
Mailing Address - Fax:
Practice Address - Street 1:125 W SCHOOL HOUSE LN
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144-3348
Practice Address - Country:US
Practice Address - Phone:215-452-5049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-10
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00820500225X00000X
PAOC015577225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist