Provider Demographics
NPI:1760431068
Name:GERACI, MICHAEL CHARLES JR (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:CHARLES
Last Name:GERACI
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:52 S UNION RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-6509
Mailing Address - Country:US
Mailing Address - Phone:716-247-5320
Mailing Address - Fax:716-276-3034
Practice Address - Street 1:52 S UNION RD
Practice Address - Street 2:SUITE 202
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-6509
Practice Address - Country:US
Practice Address - Phone:716-247-5320
Practice Address - Fax:716-276-3034
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY162259208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01039101Medicaid
NY01039101Medicaid
NY85471Medicare PIN
NY260021212Medicare PIN