Healthcare Provider Details

I. General information

NPI: 1073936662
Provider Name (Legal Business Name): GENESEE VALLEY GROUP HEALTH ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2014
Last Update Date: 02/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 BRIGHTON HENRIETTA TOWN LINE RD
ROCHESTER NY
14623-2532
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 Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

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