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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