Healthcare Provider Details

I. General information

NPI: 1699712505
Provider Name (Legal Business Name): FINGER LAKES ORTHOPEDIC SURGERY,P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 03/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 HOFFMAN ST
ELMIRA NY
14905-2263
US

IV. Provider business mailing address

300 HOFFMAN ST
ELMIRA NY
14905-2263
US

V. Phone/Fax

Practice location:
  • Phone: 607-734-4110
  • Fax: 607-734-0344
Mailing address:
  • Phone: 607-734-4110
  • Fax: 607-734-0344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number145863
License Number StateNY

VIII. Authorized Official

Name: DR. MARK D GIBSON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 607-734-4110