Provider Demographics
NPI:1467450429
Name:GENNETT, PARKER (DPM)
Entity Type:Individual
Prefix:
First Name:PARKER
Middle Name:
Last Name:GENNETT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 FOSTER RD
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-5412
Mailing Address - Country:US
Mailing Address - Phone:607-786-9072
Mailing Address - Fax:
Practice Address - Street 1:134 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905-4219
Practice Address - Country:US
Practice Address - Phone:607-723-9018
Practice Address - Fax:607-723-0715
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005004213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist