| Lifetime Health Medical Group | |
|
3045 East Avenue Central Square Health Center Central Square NY 13036 | |
| (315) 676-2935 | |
| (315) 671-6976 |
| Full Name | Lifetime Health Medical Group |
|---|---|
| Speciality | Clinic/center |
| Location | 3045 East Avenue, Central Square, New York |
| Authorized Official Name and Position | Deborah Carlascio (VICE PRESIDENT REGIONAL OPERATIONS) |
| Authorized Official Contact | 5853361400 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lifetime Health Medical Group 800 Carter Street Rochester NY 14621 Ph: (585) 339-4793 | Lifetime Health Medical Group 3045 East Avenue Central Square Health Center Central Square NY 13036 Ph: (315) 676-2935 |
| NPI Number | 1891729810 |
|---|---|
| Provider Enumeration Date | 07/10/2006 |
| Last Update Date | 09/08/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891729810 | NPI | - | NPPES |
| 00355266 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
Northern Oswego County Health Services, Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3045 East Ave, Central Square, NY 13036 Phone: 315-298-6569 |