Basic Information
| Provider Information | |||||||||
| NPI: | 1831114776 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FINGER LAKES GASTROENTEROLOGY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 821 PRE EMPTION RD STE 300 | ||||||||
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| City: | GENEVA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 144562061 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3157875310 | ||||||||
| FaxNumber: | 3157875314 | ||||||||
| Practice Location | |||||||||
| Address1: | 821 PRE EMPTION RD STE 300 | ||||||||
| Address2: | |||||||||
| City: | GENEVA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 144562061 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3157875310 | ||||||||
| FaxNumber: | 3157875314 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | LEGUYADER | ||||||||
| AuthorizedOfficialFirstName: | HENRY | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGING PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 3157875310 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.