Provider Demographics
NPI:1396790531
Name:CONEZIO, GERALD J (MD)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:J
Last Name:CONEZIO
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:P.O. BOX 584
Mailing Address - Street 2:
Mailing Address - City:CLIFTON SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:14432
Mailing Address - Country:US
Mailing Address - Phone:315-906-4201
Mailing Address - Fax:315-906-4205
Practice Address - Street 1:1331 EAST VICTOR. ROAD.
Practice Address - Street 2:
Practice Address - City:VICTOR
Practice Address - State:NY
Practice Address - Zip Code:14564
Practice Address - Country:US
Practice Address - Phone:585-924-7667
Practice Address - Fax:315-295-2128
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY125874207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
4587219OtherAETNA INSURANCE
P010125874OtherBLUE CHOICE ROCHESTER NY
4587219OtherRR MEDICARE
NY00485387Medicaid
0948OtherBC/BS ROCHESTER NY
1007358JOtherPREFERRED CARE ROCHESTER
D01595Medicare UPIN
CC5379Medicare PIN