Healthcare Provider Details

I. General information

NPI: 1457018921
Provider Name (Legal Business Name): ELISE N JOST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2021
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 SENECA ST
BUFFALO NY
14210-2324
US

IV. Provider business mailing address

227 THORN AVE STE 19
ORCHARD PARK NY
14127-2677
US

V. Phone/Fax

Practice location:
  • Phone: 716-539-5423
  • Fax: 716-887-3833
Mailing address:
  • Phone: 716-662-2040
  • Fax: 716-662-0019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: