Provider Demographics
NPI:1902956444
Name:GUSENOFF, BETH RENEE (DPM)
Entity Type:Individual
Prefix:DR
First Name:BETH
Middle Name:RENEE
Last Name:GUSENOFF
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:RENEE
Other - Last Name:FREELING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:5701 CENTRE AVE
Mailing Address - Street 2:SUITE L1
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206-3744
Mailing Address - Country:US
Mailing Address - Phone:412-361-3668
Mailing Address - Fax:412-361-4207
Practice Address - Street 1:5701 CENTRE AVE
Practice Address - Street 2:SUITE L1
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-3744
Practice Address - Country:US
Practice Address - Phone:412-361-3668
Practice Address - Fax:412-361-4207
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005650213ES0131X
PASC006330213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02059263Medicaid
NY0503470003Medicare NSC
NY02059263Medicaid
NYU80476Medicare UPIN