Healthcare Provider Details

I. General information

NPI: 1295170660
Provider Name (Legal Business Name): GENESEE VALLEY GROUP HEALTH ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2013
Last Update Date: 04/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 CARTER ST
ROCHESTER NY
14621-2604
US

IV. Provider business mailing address

333 BUTTERNUT DR 3RD FLOOR ATTN TONI RADLEY
SYRACUSE NY
13214-2141
US

V. Phone/Fax

Practice location:
  • Phone: 585-338-1200
  • Fax:
Mailing address:
  • Phone: 315-671-6951
  • Fax: 315-671-6976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. DEBORAH CARLASCIO
Title or Position: VICE PRESIDENT OF OPERATIONS
Credential:
Phone: 585-389-6066