Provider Demographics
NPI:1073619946
Name:GENSHEIMER, RICHARD J (DPM)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:GENSHEIMER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 NIAGARA FALLS BLVD
Mailing Address - Street 2:STE 208
Mailing Address - City:N TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120
Mailing Address - Country:US
Mailing Address - Phone:716-692-2160
Mailing Address - Fax:716-213-0348
Practice Address - Street 1:500 WHITNEY ROAD
Practice Address - Street 2:
Practice Address - City:PENFIELD
Practice Address - State:NY
Practice Address - Zip Code:14526-2341
Practice Address - Country:US
Practice Address - Phone:585-266-1940
Practice Address - Fax:585-266-2223
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003503-1213E00000X
NY003503213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBLUE CROSS SHIELDOther8145
NY00776669Medicaid
NYP010003503OtherBLUE CHOICE
NYBLUE CROSS SHIELDOther8145