Individual
DR. EDWARD STANLEY GENSICKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
1812 DIXWELL AVE, HAMDEN, CT 06514-3105
(203) 287-0336
(203) 287-0387
Mailing address
1812 DIXWELL AVE, HAMDEN, CT 06514-3105
(203) 287-0336
(203) 287-0387
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
P00369
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000369-7413
CONNECTICARE
CT
05
—
004067245
—
CT
01
—
030000369CT01
ANTHEM BC
CT
01
—
0V1575
HEALTH NET
CT
01
—
183481
WELLCARE
CT
01
—
4800009967
RR MEDICARE
—
01
—
P00369
STATE LICENSE
CT
01
—
P778784
OXFORD
—
Enumeration date
06/30/2006
Last updated
02/15/2008
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