Basic Information
| Provider Information | |||||||||
| NPI: | 1760516033 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GENESEE SURGICAL ASSOCIATES, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 360 LINDEN OAKS | ||||||||
| Address2: | SUITE #300 | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146252814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5853838830 | ||||||||
| FaxNumber: | 5853838918 | ||||||||
| Practice Location | |||||||||
| Address1: | 360 LINDEN OAKS | ||||||||
| Address2: | SUITE #300 | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146252814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5853838830 | ||||||||
| FaxNumber: | 5853838918 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2007 | ||||||||
| LastUpdateDate: | 03/21/2014 | ||||||||
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| AuthorizedOfficialLastName: | CALDWELL | ||||||||
| AuthorizedOfficialFirstName: | CHRISTOPHER | ||||||||
| AuthorizedOfficialMiddleName: | BRIAN | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5853838830 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | DA8680 | 01 | NY | MEDICARE TRAVELERS | OTHER | 01625016 | 05 | NY | MEDICAID |