Provider Demographics
NPI:1750487625
Name:GENESEE VALLEY GROUP HEALTH ASSOCIATION
Entity Type:Organization
Organization Name:GENESEE VALLEY GROUP HEALTH ASSOCIATION
Other - Org Name:LIFETIME HEALTH MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER, PHARMACY SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:URBANSKI
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:716-689-3420
Mailing Address - Street 1:1185 SWEET HOME RD
Mailing Address - Street 2:ATTENTION: STEVE URBANSKI
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-1018
Mailing Address - Country:US
Mailing Address - Phone:716-689-3420
Mailing Address - Fax:716-689-3472
Practice Address - Street 1:77 SULLYS TRL
Practice Address - Street 2:PERINTON HEALTH CENTER PHAMACY
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-3754
Practice Address - Country:US
Practice Address - Phone:585-248-5300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019587261QH0100X
333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1307940005Medicare ID - Type UnspecifiedPERINTON HLTH CTR PHARMAC