Provider Demographics
NPI:1164766325
Name:FLH MEDICAL, PC
Entity Type:Organization
Organization Name:FLH MEDICAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CAO
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:DISBROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-789-0993
Mailing Address - Street 1:PO BOX 1077
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456-8077
Mailing Address - Country:US
Mailing Address - Phone:315-230-5646
Mailing Address - Fax:315-230-5645
Practice Address - Street 1:821 PRE EMPTION RD
Practice Address - Street 2:STE. 300
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456-2061
Practice Address - Country:US
Practice Address - Phone:315-787-5310
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLH MEDICAL, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-11-12
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03093703Medicaid
NY03093703Medicaid