Healthcare Provider Details

I. General information

NPI: 1164766325
Provider Name (Legal Business Name): FLH MEDICAL, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2012
Last Update Date: 07/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 PRE EMPTION RD STE. 300
GENEVA NY
14456-2061
US

IV. Provider business mailing address

PO BOX 1077
GENEVA NY
14456-8077
US

V. Phone/Fax

Practice location:
  • Phone: 315-787-5310
  • Fax:
Mailing address:
  • Phone: 315-230-5646
  • Fax: 315-230-5645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: WENDY DISBROW
Title or Position: CAO
Credential:
Phone: 315-789-0993