Healthcare Provider Details

I. General information

NPI: 1205046638
Provider Name (Legal Business Name): GENESEE VALLEY GROUP HEALTH ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 CARTER ST
ROCHESTER NY
14621-2604
US

IV. Provider business mailing address

800 CARTER ST
ROCHESTER NY
14621-2604
US

V. Phone/Fax

Practice location:
  • Phone: 585-338-1400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DEBORAH CARLASCIO
Title or Position: VICE PRESIDENT REGIONAL OPERATIONS
Credential:
Phone: 585-338-1400