Individual provider Active NPI

Genill Reynoso, FNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • New York, NY
National Provider Identifier
1558829341
Registry record updated May 23, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
26NJ01151200 Issued in NJ
Practice address
4405 Broadway
New York, NY 10040
Phone
(212) 740-2020
NPI assigned
Mar 11, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 23, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 16105 CT
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 26NJ01151200 NJ Primary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 407674 NY
Family Nurse Practitioner 363LF0000X F343720-1 NY
Family Nurse Practitioner 363LF0000X 95021583 CA
Family Nurse Practitioner 363LF0000X 26NJ01151200 NJ

Addresses

Primary practice location

4405 Broadway
New York, NY 10040

Mailing address

4405 Broadway
New York, NY 10040-4014
Phone (212) 740-2020

Other practice location 1

4405 Broadway
New York, NY 10040
Phone (212) 740-2020 ext. 318

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260515003882 NJ Practitioner - Nurse Practitioner 8527394048 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

523 Park Ave
Orange, NJ 07050-1703

7 Seneca TRL
Wayne, NJ 07470-4423

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
95021583CAMDFamily Nurse Practitioner
16105CTMDFamily Nurse Practitioner
26NJ01151200NJMDFamily Nurse Practitioner
F343720-1NYMDFamily Nurse Practitioner
407674NYMDPsychiatric/Mental Health Nurse Practitioner

Networks

  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H5989

Interoperability endpoints

  • Direct secure messaging: greynoso1351356@nychhc.direct-ci.com
  • Direct secure messaging: genill.reynoso.1@24989.direct.athenahealth.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1552262400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1779494400000",
    "number": "1558829341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4405 BROADWAY",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100404014",
            "telephone_number": "212-740-2020",
            "fax_number": "646-666-0304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4405 BROADWAY",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "10040",
            "telephone_number": "212-740-2020"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4405 Broadway",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "10040",
            "country_code": "US",
            "telephone_number": "212-740-2020 x318",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "REYNOSO",
        "first_name": "GENILL",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-11",
        "last_updated": "2026-05-23",
        "certification_date": "2026-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CT",
            "license": "16105",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NJ",
            "license": "26NJ01151200",
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "407674",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "F343720-1",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95021583",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NJ",
            "license": "26NJ01151200",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.