Provider Demographics
NPI:1720001795
Name:QUEENAN, EMILY S (MD)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:S
Last Name:QUEENAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:EMILY
Other - Middle Name:C
Other - Last Name:SNYDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1501 EAST AVE
Mailing Address - Street 2:SUITE 211
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14610-1657
Mailing Address - Country:US
Mailing Address - Phone:888-494-3064
Mailing Address - Fax:888-494-3064
Practice Address - Street 1:1501 EAST AVE
Practice Address - Street 2:SUITE 211
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14610-1657
Practice Address - Country:US
Practice Address - Phone:888-494-3064
Practice Address - Fax:888-494-3064
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY240748207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00355353Medicaid
NYJ400001905Medicare PIN