Provider Demographics
NPI:1295170660
Name:GENESEE VALLEY GROUP HEALTH ASSOCIATION
Entity type:Organization
Organization Name:GENESEE VALLEY GROUP HEALTH ASSOCIATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLASCIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-389-6066
Mailing Address - Street 1:333 BUTTERNUT DR
Mailing Address - Street 2:3RD FLOOR ATTN TONI RADLEY
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13214-2141
Mailing Address - Country:US
Mailing Address - Phone:315-671-6951
Mailing Address - Fax:315-671-6976
Practice Address - Street 1:800 CARTER ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-2604
Practice Address - Country:US
Practice Address - Phone:585-338-1200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GENESEE VALLEY GROUP HEALTH ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-04-30
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00355266Medicaid
NY00355266Medicaid