MEDICARE: JANIS L. ENZENBACHER,MD,PLLC

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	207VG0400X	Gynecology Physician	162853	NY

General Provider Information

NPI Number	:	1750545885
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JANIS L. ENZENBACHER,MD,PLLC

Provider Business Mailing Address
First Line	:	105 SHAD ROW
Second Line	:	SUITE 1B
City	:	PIERMONT
State	:	NY
Zip	:	10968-3001
Country	:	US
Telephone Number	:	845-680-6600
Fax Number	:	845-680-2450

Provider Business Practice Location Address
First Line	:	105 SHAD ROW
Second Line	:	SUITE 1B
City	:	PIERMONT
State	:	NY
Zip	:	10968-3001
Country	:	US
Telephone Number	:	845-680-6600
Fax Number	:	845-680-2450

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JANIS LYNN ENZENBACHER
Credential	:	MD
Telephone Number	:	845-680-6600

Provider Enumeration Date	:	07/17/2008
Last Update Date	:	06/02/2009

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