Provider Demographics
NPI:1902528177
Name:GENESIE, ENYIAH MERCEDES (ATC)
Entity Type:Individual
Prefix:
First Name:ENYIAH
Middle Name:MERCEDES
Last Name:GENESIE
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 ADDISON RD # B-215
Mailing Address - Street 2:
Mailing Address - City:CAPITOL HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20743-1042
Mailing Address - Country:US
Mailing Address - Phone:703-944-5917
Mailing Address - Fax:
Practice Address - Street 1:2170 ROUTE 27
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-3332
Practice Address - Country:US
Practice Address - Phone:888-280-4331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00014212255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer