Provider Demographics
NPI:1629205695
Name:SHELDON H GENACK, MD, PC
Entity Type:Organization
Organization Name:SHELDON H GENACK, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHELDON
Authorized Official - Middle Name:H
Authorized Official - Last Name:GENACK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-887-5788
Mailing Address - Street 1:1728 BROADWAY
Mailing Address - Street 2:SUITE 5
Mailing Address - City:HEWLETT
Mailing Address - State:NY
Mailing Address - Zip Code:11557-1630
Mailing Address - Country:US
Mailing Address - Phone:516-887-5788
Mailing Address - Fax:516-887-5990
Practice Address - Street 1:1728 BROADWAY
Practice Address - Street 2:SUITE 5
Practice Address - City:HEWLETT
Practice Address - State:NY
Practice Address - Zip Code:11557-1630
Practice Address - Country:US
Practice Address - Phone:516-887-5788
Practice Address - Fax:516-887-5990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-17
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY198502174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY377191Medicare PIN