Healthcare Provider Details

I. General information

NPI: 1205857265
Provider Name (Legal Business Name): GENESSEE VALLEY GROUP HEALTH ASSOC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2075 SHERIDAN DR
BUFFALO NY
14223-1432
US

IV. Provider business mailing address

2075 SHERIDAN DR
BUFFALO NY
14223-1432
US

V. Phone/Fax

Practice location:
  • Phone: 716-874-1850
  • Fax: 716-879-3280
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number027327
License Number StateNY

VIII. Authorized Official

Name: CYNTHIA AMBRES
Title or Position: PRESIDENT
Credential: MD
Phone: 716-857-4587