Provider Demographics
NPI:1285813840
Name:TIFFANY B. GENEWICK, M.D., P.C.
Entity Type:Organization
Organization Name:TIFFANY B. GENEWICK, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:BOQUARD
Authorized Official - Last Name:GENICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-668-1902
Mailing Address - Street 1:4731 TRANSIT RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DEPEW
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:DEPEW
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY206982207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty