Healthcare Provider Details

I. General information

NPI: 1730254459
Provider Name (Legal Business Name): FINGER LAKES MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 02/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 NORTH ST SUITE 101
GENEVA NY
14456-1561
US

IV. Provider business mailing address

200 NORTH ST SUITE 101
GENEVA NY
14456-1561
US

V. Phone/Fax

Practice location:
  • Phone: 315-787-5100
  • Fax: 315-787-5108
Mailing address:
  • Phone: 315-787-5100
  • Fax: 315-787-5108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MARK RYAN
Title or Position: MANAGING PARTNER
Credential: M.D.
Phone: 315-787-5199