Provider Demographics
NPI:1639388291
Name:GINESE, DAWN ANITA
Entity Type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:ANITA
Last Name:GINESE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 PROSPECT HILL RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON CORNERS
Mailing Address - State:NY
Mailing Address - Zip Code:12514-2450
Mailing Address - Country:US
Mailing Address - Phone:845-266-3963
Mailing Address - Fax:
Practice Address - Street 1:96 PROSPECT HILL RD
Practice Address - Street 2:
Practice Address - City:CLINTON CORNERS
Practice Address - State:NY
Practice Address - Zip Code:12514-2450
Practice Address - Country:US
Practice Address - Phone:845-266-3963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY473287-1163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01664671Medicaid