Provider Demographics
NPI:1124364583
Name:GENEVA GENERAL HOSPITAL
Entity Type:Organization
Organization Name:GENEVA GENERAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CARDIAC REHAB DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:SUELLEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:PINEDA
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:315-787-4596
Mailing Address - Street 1:32C QUEENS WAY
Mailing Address - Street 2:
Mailing Address - City:CAMILLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13031-1764
Mailing Address - Country:US
Mailing Address - Phone:917-280-6478
Mailing Address - Fax:
Practice Address - Street 1:196 NORTH ST
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456-1651
Practice Address - Country:US
Practice Address - Phone:315-787-4596
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-12
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital