Healthcare Provider Details

I. General information

NPI: 1750487625
Provider Name (Legal Business Name): GENESEE VALLEY GROUP HEALTH ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 11/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 SULLYS TRL PERINTON HEALTH CENTER PHAMACY
PITTSFORD NY
14534-3754
US

IV. Provider business mailing address

1185 SWEET HOME RD ATTENTION: STEVE URBANSKI
AMHERST NY
14226-1018
US

V. Phone/Fax

Practice location:
  • Phone: 585-248-5300
  • Fax:
Mailing address:
  • Phone: 716-689-3420
  • Fax: 716-689-3472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number019587
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN E URBANSKI JR.
Title or Position: MANAGER, PHARMACY SERVICES
Credential: RPH
Phone: 716-689-3420