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General NPI Number Information
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NPI Number | 1184138265
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Entity Type | Organization
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Legal Business Name | GENESEE STREET MEDICAL HEALTH
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Dates
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Enumeration Date | 11/28/2017
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Last Update Date | 08/09/2018
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Provider Practice Location Address
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Address Line | 286 GENESEE ST STE 5
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City | UTICA
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State | NY
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Zip | 13502
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Country | US
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Telephone | 315-266-0600
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Fax | 315-266-0611
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Provider Business Mailing Address
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Address Line | 286 GENESEE ST STE 5
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City | UTICA
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State | NY
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Zip | 13502-4639
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Country | US
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Telephone | 315-266-0600
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Fax | 315-266-0611
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Authorized Official
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Title or Position | OWNER/ PROVIDER
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Name | MR. MINHAJ U SIDDIQI
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Credential | MD
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Telephone | 315-335-4619
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 232467
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License Number State | NY
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