1487659553 NPI number — DR. LISA MARIE GENOVESE O.D.

Table of content: (NPI 1427063551)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487659553 NPI number — DR. LISA MARIE GENOVESE O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GENOVESE
Provider First Name:
LISA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MACLAUGHLIN
Provider Other First Name:
LISA
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
OD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1487659553
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/22/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6053 CORINNE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLARENCE CENTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14032-9510
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-741-0019
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2825 NIAGARA FALLS BLVD
Provider Second Line Business Practice Location Address:
STE 130
Provider Business Practice Location Address City Name:
AMHERST
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14228-2021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-564-2020
Provider Business Practice Location Address Fax Number:
716-564-2060
Provider Enumeration Date:
06/16/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  TUV006562-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7290258 . This is a "INDEPENDENT HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000390208003 . This is a "COMMUNITY BLUE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 02443465 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 251744484 . This is a "NOVA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 251744484 . This is a "EMPIRE - UNITED HEALTHCAR" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 161578122 . This is a "EMPIRE - UNITED HEALTHCAR" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 251744484 . This is a "NORTH AMERICAN PREFERRED" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P00412826 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000390208004 . This is a "COMMUNITY BLUE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 161578122 . This is a "NOVA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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