Provider Demographics
NPI:1215979620
Name:GENUA, JILL C (MD)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:C
Last Name:GENUA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 ROMAN CT
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12211-1959
Mailing Address - Country:US
Mailing Address - Phone:203-550-1926
Mailing Address - Fax:
Practice Address - Street 1:99 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:DELMAR
Practice Address - State:NY
Practice Address - Zip Code:12054-1506
Practice Address - Country:US
Practice Address - Phone:518-262-0942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2025-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT045403208C00000X
FLME93492208C00000X
NY254384208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery