Provider Demographics
NPI:1053702993
Name:GENOVESE, MARYANN (MD)
Entity type:Individual
Prefix:DR
First Name:MARYANN
Middle Name:
Last Name:GENOVESE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:WALLKILL CORRECTIONAL FACILITY
Mailing Address - Street 2:ROUTE 208
Mailing Address - City:WALLKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12589-0286
Mailing Address - Country:US
Mailing Address - Phone:845-895-2021
Mailing Address - Fax:845-895-1886
Practice Address - Street 1:WALLKILL CORRECTIONAL FACILITY ROUTE 208
Practice Address - Street 2:
Practice Address - City:WALLKILL
Practice Address - State:NY
Practice Address - Zip Code:12589-0286
Practice Address - Country:US
Practice Address - Phone:845-895-2021
Practice Address - Fax:845-895-1886
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-13
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY148200207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine