Organization
GENESEE VALLEY GROUP HEALTH ASSOCIATION
Active
Organization
GENESEE VALLEY GROUP HEALTH ASSOCIATION
Active
Other names
Lifetime Health Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
DEBORAH CARLASCIO (VICE PRESIDENT REGIONAL OPERATIONS)
(585) 336-4841
Entity
Organization
Contact information
Practice address
1185 SWEET HOME RD, AMHERST, NY 14226-1018
(716) 668-9004
(716) 689-3467
Mailing address
1185 SWEET HOME RD, AMHERST, NY 14226-1018
(716) 689-0040
(716) 689-3467
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
—
104100000X
Social Worker
—
—
133NN1002X
Nutrition Education Nutritionist
—
—
207RG0100X
Gastroenterology Physician
—
—
2085B0100X
Body Imaging Physician
—
—
225100000X
Physical Therapist
—
—
261Q00000X
Clinic/Center
Primary
—
—
261QU0200X
Urgent Care Clinic/Center
—
—
291U00000X
Clinical Medical Laboratory
—
—
333600000X
Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3001856
—
NY
Enumeration date
07/14/2006
Last updated
08/05/2015
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