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General NPI Number Information
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NPI Number | 1821076308
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Entity Type | Organization
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Legal Business Name | ELITE MEDICAL SUPPLY
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Dates
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Enumeration Date | 01/05/2006
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Last Update Date | 09/27/2007
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Provider Practice Location Address
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Address Line | 1900 RIDGE RD
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City | WEST SENECA
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State | NY
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Zip | 14224-3332
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Country | US
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Telephone | 716-712-0881
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Fax | 716-712-0882
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Provider Business Mailing Address
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Address Line | 1900 RIDGE RD
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City | WEST SENECA
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State | NY
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Zip | 14224-3332
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Country | US
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Telephone | 716-712-0881
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Fax | 716-712-0882
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Authorized Official
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Title or Position | OWNER
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Name | MR. GARY ANTHONY NIKIEL
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Credential |
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Telephone | 716-712-0881
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225000000X
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Taxonomy Name | Orthotic Fitter
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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