Provider Demographics
NPI:1124085402
Name:GINES, ANNIE I (DPM)
Entity type:Individual
Prefix:DR
First Name:ANNIE
Middle Name:I
Last Name:GINES
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1692 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205
Mailing Address - Country:US
Mailing Address - Phone:518-869-5799
Mailing Address - Fax:518-862-1489
Practice Address - Street 1:1692 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205
Practice Address - Country:US
Practice Address - Phone:518-869-5799
Practice Address - Fax:518-862-1489
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY002852213E00000X
FLFLP00002434213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P32442OtherBCBS
10000761OtherCDPHP
NY00558961Medicaid
13722OtherGHI HMO
480011429OtherRAILROAD MEDICARE
8999992OtherGHI PPO
956200OtherMVP
000405662003OtherBS
NY37977BMedicare PIN
956200OtherMVP
NY00558961Medicaid