Provider Demographics
NPI:1942268701
Name:GENKIN, SERGEY IGOREVICH (MD)
Entity Type:Individual
Prefix:
First Name:SERGEY
Middle Name:IGOREVICH
Last Name:GENKIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 SEACOAST TER
Mailing Address - Street 2:APT. 15 E
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-6040
Mailing Address - Country:US
Mailing Address - Phone:718-891-7158
Mailing Address - Fax:718-635-6417
Practice Address - Street 1:4802 10TH AVE
Practice Address - Street 2:MAIMONIDES HOSPITAL,
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-2844
Practice Address - Country:US
Practice Address - Phone:718-283-6073
Practice Address - Fax:718-635-6417
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY222686207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7210414OtherAETNA PPO
NY02280266Medicaid
NY2593554OtherGHI
NY3055694OtherAETNA HMO
NYP2671396OtherOXFORD
NY1709660001OtherELDERPLAN
NY3055694OtherAETNA HMO
NY076AFIMedicare ID - Type Unspecified