Healthcare Provider Details

I. General information

NPI: 1932375656
Provider Name (Legal Business Name): MARTHA L GESEGNET RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2008
Last Update Date: 05/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

677 W DELAVAN AVE
BUFFALO NY
14222-1218
US

IV. Provider business mailing address

677 W DELAVAN AVE
BUFFALO NY
14222-1218
US

V. Phone/Fax

Practice location:
  • Phone: 716-883-1643
  • Fax:
Mailing address:
  • Phone: 716-883-1643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number434920
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WP0000X
TaxonomyPain Management Registered Nurse
License Number434920
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: