Provider Demographics
NPI:1740377951
Name:LOUIS B. GENNARELLI, MD, PC
Entity type:Organization
Organization Name:LOUIS B. GENNARELLI, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:B
Authorized Official - Last Name:GENNARELLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-823-3666
Mailing Address - Street 1:3250 WESTCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-4500
Mailing Address - Country:US
Mailing Address - Phone:718-823-3666
Mailing Address - Fax:718-823-3666
Practice Address - Street 1:3250 WESTCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-4500
Practice Address - Country:US
Practice Address - Phone:718-823-3666
Practice Address - Fax:718-823-3666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-07
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY109297208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1001938023Medicaid
NY300631Medicare PIN
NYB12569Medicare UPIN