Provider Demographics
NPI:1235152521
Name:TERESI, GINA A (DPM)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:A
Last Name:TERESI
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3922 W MAIN STREET RD
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:14020-9467
Mailing Address - Country:US
Mailing Address - Phone:585-344-1677
Mailing Address - Fax:585-344-2105
Practice Address - Street 1:3922 W MAIN STREET RD
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-9467
Practice Address - Country:US
Practice Address - Phone:585-344-1677
Practice Address - Fax:585-344-2105
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003841 1213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000500792005OtherBCWNY DME
CC9210OtherME PIN
01OtherME LOCALITY
AA1027OtherME GROUP
00010353901OtherCHOICE CARE
P010003841OtherBLUE CHOICE
000500792003OtherBCWNY
G0181304190OtherBLUE CHOICE GROUP
8904032OtherIH
9648089OtherGHI GROUP
000500792003OtherCB
NY00928309Medicaid
NY02205076Medicaid
1499716OtherGHI
5654324OtherAETNA
051203000031OtherFIDELIS
CC9210OtherME PIN
8904032OtherIH
4375000001Medicare NSC
000500792003OtherCB