Prime Medical of the Finger Lakes PLLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

232779-1 Issued in NY

Legal business name

PRIME MEDICAL OF THE FINGER LAKES PLLC

Practice address

1150 State Route 5 and 20
Geneva, NY 14456-9543

Phone

(315) 759-5319

Fax

(315) 759-5339

NPI assigned

Jul 12, 2011

Organization subpart

No

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

Authorized official

Name

Charbel G Moussallem, M.D.

Title

Owner

Phone

(315) 663-7259

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1310428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1341273600000",
    "number": "1659669588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1150 STATE ROUTE 5 AND 20",
            "city": "GENEVA",
            "state": "NY",
            "postal_code": "144569543",
            "telephone_number": "315-759-5319",
            "fax_number": "315-759-5339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1150 STATE ROUTE 5 AND 20",
            "city": "GENEVA",
            "state": "NY",
            "postal_code": "144569543",
            "telephone_number": "315-759-5319",
            "fax_number": "315-759-5339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME MEDICAL OF THE FINGER LAKES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-12",
        "last_updated": "2012-07-03",
        "status": "A",
        "authorized_official_last_name": "MOUSSALLEM",
        "authorized_official_first_name": "CHARBEL",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "315-663-7259",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "232779-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03358610",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Geneva, NY
• Providers in Geneva, NY by specialty
• Internal Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2012; 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.