Provider Demographics
NPI:1629252150
Name:KARI W BOVENZI DBA GENESIS PEDIATRICS
Entity type:Organization
Organization Name:KARI W BOVENZI DBA GENESIS PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KARI
Authorized Official - Middle Name:
Authorized Official - Last Name:BOVENZI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-489-6822
Mailing Address - Street 1:638 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-1830
Mailing Address - Country:US
Mailing Address - Phone:518-489-6822
Mailing Address - Fax:518-489-4040
Practice Address - Street 1:638 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-1830
Practice Address - Country:US
Practice Address - Phone:518-489-6822
Practice Address - Fax:518-489-4040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-19
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY191281208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty