MEDICARE: JEFFREY GENSHAFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332H00000X	Eyewear Supplier	003638	NY

General Provider Information

NPI Number	:	1437398500
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEFFREY GENSHAFT

Provider Business Mailing Address
First Line	:	4246 ALBANY POST RD
Second Line	:
City	:	HYDE PARK
State	:	NY
Zip	:	12538-1700
Country	:	US
Telephone Number	:	845-229-9118
Fax Number	:	845-229-9505

Provider Business Practice Location Address
First Line	:	4246 ALBANY POST RD
Second Line	:
City	:	HYDE PARK
State	:	NY
Zip	:	12538-1700
Country	:	US
Telephone Number	:	845-229-9118
Fax Number	:	845-229-9505

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JEFFREY J GENSHAFT
Credential	:	OD
Telephone Number	:	845-229-9118

Provider Enumeration Date	:	02/13/2009
Last Update Date	:	02/13/2009

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