Healthcare Provider Details

I. General information

NPI: 1790364131
Provider Name (Legal Business Name): JANICE M GENNOCRO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2021
Last Update Date: 10/20/2021
Certification Date: 10/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3950 E ROBINSON RD STE 109
AMHERST NY
14228-2042
US

IV. Provider business mailing address

6941 WILLIAMS RD
NIAGARA FALLS NY
14304-3022
US

V. Phone/Fax

Practice location:
  • Phone: 716-629-3338
  • Fax: 716-304-6571
Mailing address:
  • Phone: 716-629-3338
  • Fax: 716-304-6571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF347137-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: