Provider Demographics
NPI:1952899957
Name:GENESIS METABOLICS LLC
Entity Type:Organization
Organization Name:GENESIS METABOLICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT/MEMBER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:RUSSOMANO
Authorized Official - Suffix:
Authorized Official - Credentials:RN BSN
Authorized Official - Phone:908-851-0455
Mailing Address - Street 1:2801 MORRIS AVE
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-4821
Mailing Address - Country:US
Mailing Address - Phone:908-851-0455
Mailing Address - Fax:908-851-0708
Practice Address - Street 1:2801 MORRIS AVE
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-4821
Practice Address - Country:US
Practice Address - Phone:908-851-0455
Practice Address - Fax:908-851-0708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-25
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty