Provider Demographics
NPI:1386825875
Name:GEISBUESCH, JUDITH DILDINE
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:DILDINE
Last Name:GEISBUESCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6720 PITTSFORD PALMYRA RD
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-3344
Mailing Address - Country:US
Mailing Address - Phone:585-223-1460
Mailing Address - Fax:585-223-5139
Practice Address - Street 1:6720 PITTSFORD PALMYRA RD
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-3344
Practice Address - Country:US
Practice Address - Phone:585-223-1460
Practice Address - Fax:585-223-5139
Is Sole Proprietor?:No
Enumeration Date:2007-11-26
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035365183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00446942Medicaid