MEDICARE: JOHN JOSEPH GARNEAU JR. M.D.

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	207R00000X	Internal Medicine Physician	174390	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	124H	OTHER	NY	PREFERRED ARE NUMBER
3	010174390	OTHER	NY	BLUE CHOICE NUMBER

General Provider Information

NPI Number	:	1871525154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN JOSEPH GARNEAU JR. M.D.

Provider Business Mailing Address
First Line	:	3875 E HENRIETTA RD
Second Line	:
City	:	HENRIETTA
State	:	NY
Zip	:	14467-9147
Country	:	US
Telephone Number	:	585-334-4200
Fax Number	:	585-334-2515

Provider Business Practice Location Address
First Line	:	3875 E HENRIETTA RD
Second Line	:
City	:	HENRIETTA
State	:	NY
Zip	:	14467-9147
Country	:	US
Telephone Number	:	585-334-4200
Fax Number	:	585-334-2515

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	03/07/2023

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