=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013166818
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ERIE COUNTY MEDICAL CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/17/2008
-----------------------------------------------------
Last Update Date | 09/17/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 119 WALTERCREST TER
-----------------------------------------------------
City | WEST SENECA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14224-3843
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-308-2528
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 119 WALTERCREST TER
-----------------------------------------------------
City | WEST SENECA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14224-3843
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-308-2528
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SPECIAL EDUCATION TEACHER
-----------------------------------------------------
Name | MRS. RENEE F. IDE
-----------------------------------------------------
Credential | MS., ED
-----------------------------------------------------
Telephone | 716-826-8010
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 252Y00000X
-----------------------------------------------------
Taxonomy Name | Early Intervention Provider Agency
-----------------------------------------------------
License Number | 959012991
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------