Provider Demographics
NPI:1700073038
Name:GENADIJ SIENKIEWICZ MD, PC
Entity Type:Organization
Organization Name:GENADIJ SIENKIEWICZ MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GENADIJ
Authorized Official - Middle Name:
Authorized Official - Last Name:SIENKIEWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:607-727-1019
Mailing Address - Street 1:3117 KNAPP RD
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-3038
Mailing Address - Country:US
Mailing Address - Phone:607-727-1019
Mailing Address - Fax:
Practice Address - Street 1:507 MAIN ST
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790-1810
Practice Address - Country:US
Practice Address - Phone:607-727-1019
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01956463Medicaid
NY00685727Medicaid
NYAA0042Medicare PIN
NY00685727Medicaid