Healthcare Provider Details

I. General information

NPI: 1689615924
Provider Name (Legal Business Name): GREGORY G CARNEVALE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 ELIZABETH BLACKWELL ST STE A
GENEVA NY
14456-3443
US

IV. Provider business mailing address

601 ELMWOOD AVE BOX 629
ROCHESTER NY
14642-0001
US

V. Phone/Fax

Practice location:
  • Phone: 315-789-2153
  • Fax:
Mailing address:
  • Phone: 275-758-5732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number213138
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207YS0012X
TaxonomySleep Medicine (Otolaryngology) Physician
License Number213138
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number213138
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code207YS0012X
TaxonomySleep Medicine (Otolaryngology) Physician
License NumberP1854
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number36.152276
License Number StateIL
# 6
Primary TaxonomyN
Taxonomy Code207YS0012X
TaxonomySleep Medicine (Otolaryngology) Physician
License Number36.152276
License Number StateIL
# 7
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number213138
License Number StateNY
# 8
Primary TaxonomyN
Taxonomy Code207YS0012X
TaxonomySleep Medicine (Otolaryngology) Physician
License Number37503
License Number StateOK
# 9
Primary TaxonomyN
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number36.152276
License Number StateIL
# 10
Primary TaxonomyN
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number36.152276
License Number StateIL
# 11
Primary TaxonomyN
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number213138
License Number StateNY
# 12
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number213138
License Number StateNY
# 13
Primary TaxonomyN
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number213138
License Number StateNY
# 14
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number36.152276
License Number StateIL
# 15
Primary TaxonomyN
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number36.152276
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: