Provider Demographics
NPI:1780765370
Name:GREGORY G. CARNEVALE,M.D,L.L.C.
Entity type:Organization
Organization Name:GREGORY G. CARNEVALE,M.D,L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:G
Authorized Official - Last Name:CARNEVALE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-789-2153
Mailing Address - Street 1:784 PRE EMPTION RD
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456-2018
Mailing Address - Country:US
Mailing Address - Phone:315-789-2153
Mailing Address - Fax:315-789-4781
Practice Address - Street 1:784 PRE EMPTION RD
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456-2018
Practice Address - Country:US
Practice Address - Phone:315-789-2153
Practice Address - Fax:315-789-4781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
Not Answered207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic AllergyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02360790Medicaid
NY02360790Medicaid