Provider Demographics
NPI:1437398500
Name:JEFFREY GENSHAFT
Entity Type:Organization
Organization Name:JEFFREY GENSHAFT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:J
Authorized Official - Last Name:GENSHAFT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:845-229-9118
Mailing Address - Street 1:4246 ALBANY POST RD
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12538-1700
Mailing Address - Country:US
Mailing Address - Phone:845-229-9118
Mailing Address - Fax:845-229-9505
Practice Address - Street 1:4246 ALBANY POST RD
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:12538-1700
Practice Address - Country:US
Practice Address - Phone:845-229-9118
Practice Address - Fax:845-229-9505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-13
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003638332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0282040001Medicare NSC