Provider Demographics
NPI:1831751502
Name:MARUCA, GENELLE-LEE MARGUERITE
Entity type:Individual
Prefix:
First Name:GENELLE-LEE
Middle Name:MARGUERITE
Last Name:MARUCA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9109 165TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOWARD BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11414-3738
Mailing Address - Country:US
Mailing Address - Phone:917-488-5830
Mailing Address - Fax:
Practice Address - Street 1:15801 CROSSBAY BLVD
Practice Address - Street 2:
Practice Address - City:HOWARD BEACH
Practice Address - State:NY
Practice Address - Zip Code:11414-3140
Practice Address - Country:US
Practice Address - Phone:718-848-0875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-02
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist