Healthcare Provider Details

I. General information

NPI: 1144278664
Provider Name (Legal Business Name): TIFFANY BOQUARD GENEWICK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 09/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4731 TRANSIT RD SUITE 1
LANCASTER NY
14043-4884
US

IV. Provider business mailing address

4731 TRANSIT RD SUITE 1
LANCASTER NY
14043-4884
US

V. Phone/Fax

Practice location:
  • Phone: 716-668-1902
  • Fax: 716-668-1919
Mailing address:
  • Phone: 716-668-1902
  • Fax: 716-668-1919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number206982
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: