Provider Demographics
NPI:1043266075
Name:VICTORIA A GENSEMER D.P.M., P.A.
Entity Type:Organization
Organization Name:VICTORIA A GENSEMER D.P.M., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:GENSEMER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:561-498-9888
Mailing Address - Street 1:5210 LINTON BLVD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-6542
Mailing Address - Country:US
Mailing Address - Phone:561-498-9888
Mailing Address - Fax:561-498-7626
Practice Address - Street 1:5210 LINTON BLVD
Practice Address - Street 2:SUITE 305
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-6542
Practice Address - Country:US
Practice Address - Phone:561-498-9888
Practice Address - Fax:561-498-7626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3138213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL21293672428OtherBEECH STREET
FL10861438OtherGHI
FL1955132OtherCIGNA
FL9432177OtherPHCS
FL65884OtherBCBS
FLK9820Medicare PIN
FL21293672428OtherBEECH STREET
FLV02169Medicare UPIN