Healthcare Provider Details

I. General information

NPI: 1083731566
Provider Name (Legal Business Name): GENESEE VALLEY GROUP HEALTH ASSOCATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 EMPIRE DR
WEST SENECA NY
14224-1320
US

IV. Provider business mailing address

130 EMPIRE DR
WEST SENECA NY
14224-1320
US

V. Phone/Fax

Practice location:
  • Phone: 716-668-6170
  • Fax:
Mailing address:
  • Phone: 716-668-6170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

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