Provider Demographics
NPI:1831114776
Name:FINGER LAKES GASTROENTEROLOGY
Entity Type:Organization
Organization Name:FINGER LAKES GASTROENTEROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEGUYADER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-787-5310
Mailing Address - Street 1:821 PRE EMPTION RD STE 300
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456-2061
Mailing Address - Country:US
Mailing Address - Phone:315-787-5310
Mailing Address - Fax:315-787-5314
Practice Address - Street 1:821 PRE EMPTION RD STE 300
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456-2061
Practice Address - Country:US
Practice Address - Phone:315-787-5310
Practice Address - Fax:315-787-5314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA1657Medicare ID - Type Unspecified