Provider Demographics
NPI:1174872444
Name:TAYLOR, GENNELLE CATIA
Entity type:Individual
Prefix:
First Name:GENNELLE
Middle Name:CATIA
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 CENTRAL PARK W
Mailing Address - Street 2:SUITE 4
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-3008
Mailing Address - Country:US
Mailing Address - Phone:718-578-8011
Mailing Address - Fax:516-249-0150
Practice Address - Street 1:295 CENTRAL PARK W
Practice Address - Street 2:SUITE 4
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-3008
Practice Address - Country:US
Practice Address - Phone:718-578-8011
Practice Address - Fax:516-249-0150
Is Sole Proprietor?:No
Enumeration Date:2012-09-02
Last Update Date:2012-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist