Provider Demographics
NPI:1811917685
Name:GENAU, JOSEPH M (DO)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:M
Last Name:GENAU
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:105 EXETER RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-3312
Mailing Address - Country:US
Mailing Address - Phone:716-634-5204
Mailing Address - Fax:
Practice Address - Street 1:7 COMMUNITY DR
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-2523
Practice Address - Country:US
Practice Address - Phone:716-505-5630
Practice Address - Fax:716-892-1936
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008272-1208100000X
NYN005026213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00010252003OtherUNIVERA
NY000511813004OtherBLUE CROSS/BLUE SHIELD
NY1093490001OtherMEDICARE DME
NY480020050OtherMEDICARE RAILROAD
NY000511813004OtherBLUE CROSS/BLUE SHIELD