Provider Demographics
NPI:1487889804
Name:GENESEE VALLEY PAIN MANAGEMENT LLC
Entity type:Organization
Organization Name:GENESEE VALLEY PAIN MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NASEER
Authorized Official - Middle Name:A
Authorized Official - Last Name:TAHIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-271-4280
Mailing Address - Street 1:2050 SOUTH CLINTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618
Mailing Address - Country:US
Mailing Address - Phone:585-271-4280
Mailing Address - Fax:585-271-4311
Practice Address - Street 1:2050 S CLINTON AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-5727
Practice Address - Country:US
Practice Address - Phone:585-271-4280
Practice Address - Fax:585-271-4311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-29
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ130235207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG0185496590OtherBLUE CHOICE
NY100772AHOtherPREFERRED CARE