Provider Demographics
NPI:1821171703
Name:ENZENBACHER, JANIS L (MD, PLLC)
Entity Type:Individual
Prefix:
First Name:JANIS
Middle Name:L
Last Name:ENZENBACHER
Suffix:
Gender:F
Credentials:MD, PLLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 CEDAR HILL AVE STE 1B
Mailing Address - Street 2:
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-3703
Mailing Address - Country:US
Mailing Address - Phone:191-432-5166
Mailing Address - Fax:845-680-2450
Practice Address - Street 1:97 CEDAR HILL AVE STE 1B
Practice Address - Street 2:
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-3703
Practice Address - Country:US
Practice Address - Phone:191-432-5166
Practice Address - Fax:845-675-4986
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY162853-1207VG0400X
NY162853207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY162853-1OtherLICENSE
NY162853-1OtherLICENSE
NYA60220Medicare UPIN