Provider Demographics
NPI:1225241557
Name:EXTENDED MEDICAL SERVICES
Entity Type:Organization
Organization Name:EXTENDED MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTICIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:585-671-4660
Mailing Address - Street 1:6824 KNICKERBOCKER RD
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:NY
Mailing Address - Zip Code:14519-9741
Mailing Address - Country:US
Mailing Address - Phone:315-524-4049
Mailing Address - Fax:315-524-4049
Practice Address - Street 1:811 RIDGE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-2410
Practice Address - Country:US
Practice Address - Phone:585-671-4660
Practice Address - Fax:585-671-4668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY333050363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty