Healthcare Provider Details

I. General information

NPI: 1740388719
Provider Name (Legal Business Name): ELDER MEDICAL SERVICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 03/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 CAYUGA RD SUITE 1-C
CHEEKTOWAGA NY
14225-1942
US

IV. Provider business mailing address

132 CAYUGA RD SUITE 1-C
CHEEKTOWAGA NY
14225-1942
US

V. Phone/Fax

Practice location:
  • Phone: 716-204-9711
  • Fax: 716-204-9717
Mailing address:
  • Phone: 716-204-9711
  • Fax: 716-204-9717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. BETH HOERNER
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 716-204-9710