Provider Demographics
NPI:1770784332
Name:GENEVIEVE S G LEY MD INC
Entity type:Organization
Organization Name:GENEVIEVE S G LEY MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-536-0300
Mailing Address - Street 1:PO BOX 25668
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96825-0668
Mailing Address - Country:US
Mailing Address - Phone:808-536-0300
Mailing Address - Fax:808-536-0320
Practice Address - Street 1:2228 LILIHA ST STE 300
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-1653
Practice Address - Country:US
Practice Address - Phone:808-585-7414
Practice Address - Fax:808-585-7424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD11242207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIH55651Medicare ID - Type Unspecified
HIH64478Medicare UPIN