Provider Demographics
NPI:1588850556
Name:GEEMSON OO M.D. PLLC
Entity Type:Organization
Organization Name:GEEMSON OO M.D. PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEEMSON
Authorized Official - Middle Name:
Authorized Official - Last Name:OO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-712-0920
Mailing Address - Street 1:3775 SENECA ST
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-3434
Mailing Address - Country:US
Mailing Address - Phone:716-712-0920
Mailing Address - Fax:716-712-0922
Practice Address - Street 1:3775 SENECA ST
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-3434
Practice Address - Country:US
Practice Address - Phone:716-712-0920
Practice Address - Fax:716-712-0922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY226696207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBA1231Medicare PIN
NYH 78503Medicare UPIN