Provider Demographics
NPI:1851356810
Name:KOENIG, JEANNIE KAO (MD)
Entity Type:Individual
Prefix:DR
First Name:JEANNIE
Middle Name:KAO
Last Name:KOENIG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 563
Mailing Address - Street 2:
Mailing Address - City:GETZVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14068-0563
Mailing Address - Country:US
Mailing Address - Phone:716-870-5340
Mailing Address - Fax:716-639-5961
Practice Address - Street 1:565 ABBOTT RD
Practice Address - Street 2:REHABILITATION DEPARTMENT
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14220-2039
Practice Address - Country:US
Practice Address - Phone:716-821-4450
Practice Address - Fax:716-828-2765
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2010-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2213431208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02273398Medicaid
NY3011286OtherINDEPENDENT HEALTH
NY000526519004OtherBLUE CROSS
NY00025687702OtherUNIVERA
P00333863OtherMEDICARE RR
NY3011286OtherINDEPENDENT HEALTH
NYIA1017Medicare PIN