Healthcare Provider Details

I. General information

NPI: 1063400521
Provider Name (Legal Business Name): ELIZABETH LOVE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 11/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 POWERS RD
ORCHARD PARK NY
14127-4841
US

IV. Provider business mailing address

2875 UNION RD SUITE 8
CHEEKTOWAGA NY
14227-1465
US

V. Phone/Fax

Practice location:
  • Phone: 716-667-0001
  • Fax: 716-667-0028
Mailing address:
  • Phone: 716-651-0911
  • Fax: 716-651-9855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number200473
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: