| Genesee Street Medical Health | |
|
286 Genesee St Ste 5 Utica NY 13502 | |
| (315) 266-0600 | |
| (315) 266-0611 |
| Full Name | Genesee Street Medical Health |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 286 Genesee St Ste 5, Utica, New York |
| Authorized Official Name and Position | Minhaj U Siddiqi (OWNER/ PROVIDER) |
| Authorized Official Contact | 3153354619 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Genesee Street Medical Health 286 Genesee St Ste 5 Utica NY 13502-4639 Ph: (315) 266-0600 | Genesee Street Medical Health 286 Genesee St Ste 5 Utica NY 13502 Ph: (315) 266-0600 |
| NPI Number | 1184138265 |
|---|---|
| Provider Enumeration Date | 11/28/2017 |
| Last Update Date | 08/09/2018 |
| Medicare PECOS PAC ID | 4385994540 |
|---|---|
| Medicare Enrollment ID | O20180910000461 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184138265 | NPI | - | NPPES |
| 04989199 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 232467 (New York) | Primary |
| Provider Name | Minhaj Uddin Siddiqi |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1598858458 PECOS PAC ID: 4486695038 Enrollment ID: I20050513000537 |
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