MEDICARE: GENESEE VALLEY GROUP HEALTH ASSOCIATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891729810
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENESEE VALLEY GROUP HEALTH ASSOCIATION

Provider Business Mailing Address
First Line	:	800 CARTER STREET
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14621
Country	:	US
Telephone Number	:	585-339-4793
Fax Number	:	585-336-4845

Provider Business Practice Location Address
First Line	:	3045 EAST AVENUE
Second Line	:	CENTRAL SQUARE HEALTH CENTER
City	:	CENTRAL SQUARE
State	:	NY
Zip	:	13036
Country	:	US
Telephone Number	:	315-676-2935
Fax Number	:	315-671-6976

Authorized Official
Title or Position	:	VICE PRESIDENT REGIONAL OPERATIONS
Name	:	DEBORAH CARLASCIO
Credential	:
Telephone Number	:	585-336-1400

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	09/08/2008

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