Provider Demographics
NPI:1700155017
Name:GENAO'S MEDICAL SUPPLY LLC
Entity Type:Organization
Organization Name:GENAO'S MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAYRELI
Authorized Official - Middle Name:
Authorized Official - Last Name:GENAO
Authorized Official - Suffix:
Authorized Official - Credentials:DME SPECIALIST
Authorized Official - Phone:732-324-8700
Mailing Address - Street 1:471 NEW BRUNSWICK AVE
Mailing Address - Street 2:
Mailing Address - City:PERTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08861-3646
Mailing Address - Country:US
Mailing Address - Phone:732-324-7800
Mailing Address - Fax:
Practice Address - Street 1:471 NEW BRUNSWICK AVE
Practice Address - Street 2:
Practice Address - City:PERTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08861-3646
Practice Address - Country:US
Practice Address - Phone:732-324-7800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-16
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ60096699OtherHORIZON NJ HEALTH
NJ01640863OtherAMERIGROUP OF NJ
NJ6624830001Medicare NSC