Provider Demographics
NPI:1144278664
Name:GENEWICK, TIFFANY BOQUARD (MD)
Entity type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:BOQUARD
Last Name:GENEWICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:4731 TRANSIT RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LANCASTER
Mailing Address - State:NY
Mailing Address - Zip Code:14043-4884
Mailing Address - Country:US
Mailing Address - Phone:716-668-1902
Mailing Address - Fax:716-668-1919
Practice Address - Street 1:4731 TRANSIT RD
Practice Address - Street 2:SUITE 1
Practice Address - City:LANCASTER
Practice Address - State:NY
Practice Address - Zip Code:14043-4884
Practice Address - Country:US
Practice Address - Phone:716-668-1902
Practice Address - Fax:716-668-1919
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY206982207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBA0463OtherMEDICARE GROUP
NY02089605Medicaid
NYH24039Medicare UPIN
NY02089605Medicaid