Provider Demographics
NPI:1932427580
Name:GENNA, GREGORY (AUD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:GENNA
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3855 BLAIR MILL RD
Mailing Address - Street 2:APT 234D
Mailing Address - City:HORSHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19044-2998
Mailing Address - Country:US
Mailing Address - Phone:412-378-1515
Mailing Address - Fax:
Practice Address - Street 1:8380 OLD YORK RD
Practice Address - Street 2:STE 120
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-1539
Practice Address - Country:US
Practice Address - Phone:215-780-3186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-06
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT006155231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist