Active NPI
Cory Vandeusen, RPH
- Pharmacist
- Geneva, NY
National Provider Identifier
1730402173
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 052615
- Practice address
- 300 Hamilton St
Geneva, NY 14456-2913 - Phone
- (315) 781-7737
- Fax
- (315) 781-1346
- NPI assigned
- Mar 11, 2010
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 052615 | NY | Primary |
Addresses
Primary practice location
300 Hamilton St
Geneva, NY 14456-2913
Mailing address
300 Hamilton St
Geneva, NY 14456-2913
Phone (315) 781-7737
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 052615 | Other | NY | PHARMACIST LICENSE # |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 052615 | NY | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wegmans Food Markets, Inc. | Past | Accepting new patients | |
| Wegmans Food Markets, Inc. | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1268265600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1268265600000",
"number": "1730402173",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 HAMILTON ST",
"city": "GENEVA",
"state": "NY",
"postal_code": "144562913",
"telephone_number": "315-781-7737",
"fax_number": "315-781-1346"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 HAMILTON ST",
"city": "GENEVA",
"state": "NY",
"postal_code": "144562913",
"telephone_number": "315-781-7737",
"fax_number": "315-781-1346"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANDEUSEN",
"first_name": "CORY",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-03-11",
"last_updated": "2010-03-11",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "052615",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHARMACIST LICENSE #",
"identifier": "052615",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Geneva, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.