NPIMap

Organization Active NPI

Genesee Valley Group Health Association

Doing business as Lifetime Health Medical Group

  • Psychologist
  • West Seneca, NY
National Provider Identifier
1174649925
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Legal business name
GENESEE VALLEY GROUP HEALTH ASSOCIATION
Doing business as
Lifetime Health Medical Group
Practice address
130 Empire Dr
West Seneca, NY 14224-1320
Phone
(716) 668-6170
NPI assigned
Mar 22, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Deborah Carlascio
Title
Vice President Regional Operations
Phone
(585) 338-1400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X Primary

Addresses

Primary practice location

130 Empire Dr
West Seneca, NY 14224-1320

Mailing address

130 Empire Dr
West Seneca, NY 14224-1320
Phone (716) 668-6170

Other identifiers 1

IdentifierTypeStateIssuer
00011283019OtherNYGROUP# BEH HEALTH PHD

Other names 1

  • Lifetime Health Medical Group Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Daniel B Wopperer52 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

130 Empire Dr
West Seneca, NY 14224
Phone (716) 668-6170

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1174649925",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 EMPIRE DR",
            "city": "WEST SENECA",
            "state": "NY",
            "postal_code": "142241320",
            "telephone_number": "716-668-6170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 EMPIRE DR",
            "city": "WEST SENECA",
            "state": "NY",
            "postal_code": "142241320",
            "telephone_number": "716-668-6170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENESEE VALLEY GROUP HEALTH ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CARLASCIO",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_title_or_position": "VICE PRESIDENT REGIONAL OPERATIONS",
        "authorized_official_telephone_number": "585-338-1400"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP# BEH HEALTH PHD",
            "identifier": "00011283019",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lifetime Health Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in West Seneca, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.