Provider Demographics
NPI:1942205885
Name:GENSHAFT, JEFFREY (OD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:GENSHAFT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4246 ALBANY POST RD
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12538-1700
Mailing Address - Country:US
Mailing Address - Phone:845-229-9118
Mailing Address - Fax:
Practice Address - Street 1:4246 ALBANY POST RD
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:12538-1700
Practice Address - Country:US
Practice Address - Phone:845-229-9118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV003638-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00643949Medicaid
NYJG0C293510Medicare PIN
NYU29113Medicare UPIN
NY00643949Medicaid