=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750482154
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LAKEVIEW EAR NOSE & THROAT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/26/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 151 FOOTE AVENUE
-----------------------------------------------------
City | JAMESTOWN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-486-2342
-----------------------------------------------------
Fax | 716-661-9304
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 151 FOOTE AVENUE
-----------------------------------------------------
City | JAMESTOWN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-486-2342
-----------------------------------------------------
Fax | 716-661-9304
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN/OWNER
-----------------------------------------------------
Name | DR. ELLEN A WEINBERG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 716-483-2342
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Y00000X
-----------------------------------------------------
Taxonomy Name | Otolaryngology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------