Basic Information
| Provider Information | |||||||||
| NPI: | 1346623386 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GENESIS ELDERCARE PHYSICIANS SERVICES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 42738 | ||||||||
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| City: | TOWSON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212842738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108327790 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1201 DALY DR | ||||||||
| Address2: | |||||||||
| City: | NEW HAVEN | ||||||||
| State: | IN | ||||||||
| PostalCode: | 467741891 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2607490413 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2015 | ||||||||
| LastUpdateDate: | 04/13/2018 | ||||||||
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| AuthorizedOfficialLastName: | SHAPIRO | ||||||||
| AuthorizedOfficialFirstName: | ERIC | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP/AREA CONTROLLER | ||||||||
| AuthorizedOfficialTelephone: | 4108327790 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0300X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
No ID Information.