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NPI Code Detail

MEDICARE: GENESEE VALLEY GROUP HEALTH

MEDICARE: GENESEE VALLEY GROUP HEALTH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QU0200XUrgent Care Clinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1396158291
Entity Type Code : Organization
Provider Name (Legal Business Name) : GENESEE VALLEY GROUP HEALTH
Provider Business Mailing Address
First Line : 333 BUTTERNUT DR
Second Line :
City : SYRACUSE
State : NY
Zip : 13214-2141
Country : US
Telephone Number : 315-671-6951
Fax Number :
Provider Business Practice Location Address
First Line : 470 LONG POND RD
Second Line :
City : ROCHESTER
State : NY
Zip : 14612-3057
Country : US
Telephone Number : 585-227-8322
Fax Number :
Authorized Official
Title or Position : VICE PRESIDENT OF OPERATIONS
Name : DEB CARLASCIO
Credential :
Telephone Number : 585-389-6066
Provider Enumeration Date : 06/09/2014
Last Update Date : 06/09/2014

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