Healthcare Provider Details

I. General information

NPI: 1215979620
Provider Name (Legal Business Name): JILL C GENUA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 03/23/2025
Certification Date: 03/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 DELAWARE AVE
DELMAR NY
12054-1506
US

IV. Provider business mailing address

5 ROMAN CT
ALBANY NY
12211-1959
US

V. Phone/Fax

Practice location:
  • Phone: 518-262-0942
  • Fax:
Mailing address:
  • Phone: 203-550-1926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number045403
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberME93492
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number254384
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: