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) 338-1400
Entity
Organization
Contact information
Practice address
130 EMPIRE DR, WEST SENECA, NY 14224-1320
(716) 668-6170
Mailing address
130 EMPIRE DR, WEST SENECA, NY 14224-1320
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DC7264
MEDICARE RAILROAD GROUP #
NY
Enumeration date
05/24/2007
Last updated
08/22/2020
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