Provider Demographics
NPI:1033165337
Name:CLEVELAND HILL MEDICAL GROUP, PC
Entity Type:Organization
Organization Name:CLEVELAND HILL MEDICAL GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCHLENKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-837-7130
Mailing Address - Street 1:539 CLEVELAND DR
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-1024
Mailing Address - Country:US
Mailing Address - Phone:716-834-9486
Mailing Address - Fax:716-834-6466
Practice Address - Street 1:539 CLEVELAND DR
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-1024
Practice Address - Country:US
Practice Address - Phone:716-834-9486
Practice Address - Fax:716-834-6466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY178816207Q00000X
NY161094207R00000X
NY161110207R00000X
NYF333678363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01246611Medicaid
NY00889592Medicaid
NY00886402Medicaid
NYP73953Medicare UPIN
NYE82918Medicare UPIN
NY00889592Medicaid
NY00886402Medicaid
NYD01419Medicare UPIN
NYB47991Medicare ID - Type Unspecified
NYDD3455Medicare ID - Type Unspecified
NYD47991Medicare ID - Type Unspecified