Provider Demographics
NPI:1639305089
Name:GENESIS INTERNAL MEDICINE PLLC
Entity Type:Organization
Organization Name:GENESIS INTERNAL MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MGR
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:QUIBEIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-335-2210
Mailing Address - Street 1:50 E SOUTH ST.
Mailing Address - Street 2:SUITE 600
Mailing Address - City:GENESEO
Mailing Address - State:NY
Mailing Address - Zip Code:14454
Mailing Address - Country:US
Mailing Address - Phone:585-243-5109
Mailing Address - Fax:585-243-5124
Practice Address - Street 1:50 E SOUTH ST.
Practice Address - Street 2:SUITE 600
Practice Address - City:GENESEO
Practice Address - State:NY
Practice Address - Zip Code:14454
Practice Address - Country:US
Practice Address - Phone:585-243-5109
Practice Address - Fax:585-243-5124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-29
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY234105207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRA4923Medicare UPIN