Provider Demographics
NPI:1669579256
Name:GENESEE CARDIOLOGY AND INTERNAL MEDICINE ASSOCIATES LLC
Entity type:Organization
Organization Name:GENESEE CARDIOLOGY AND INTERNAL MEDICINE ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MAIDUL
Authorized Official - Middle Name:I
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-343-4440
Mailing Address - Street 1:229 SUMMIT ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BATAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:14020-1645
Mailing Address - Country:US
Mailing Address - Phone:585-343-4440
Mailing Address - Fax:585-343-0381
Practice Address - Street 1:229 SUMMIT ST
Practice Address - Street 2:SUITE 1
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-1645
Practice Address - Country:US
Practice Address - Phone:585-343-4440
Practice Address - Fax:585-343-0381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY14460AMedicare ID - Type UnspecifiedMEDICARE PROVIDER ID