Healthcare Provider Details

I. General information

NPI: 1891729810
Provider Name (Legal Business Name): GENESEE VALLEY GROUP HEALTH ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 09/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3045 EAST AVENUE CENTRAL SQUARE HEALTH CENTER
CENTRAL SQUARE NY
13036
US

IV. Provider business mailing address

800 CARTER STREET
ROCHESTER NY
14621
US

V. Phone/Fax

Practice location:
  • Phone: 315-676-2935
  • Fax: 315-671-6976
Mailing address:
  • Phone: 585-339-4793
  • Fax: 585-336-4845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DEBORAH CARLASCIO
Title or Position: VICE PRESIDENT REGIONAL OPERATIONS
Credential:
Phone: 585-336-1400