Provider Demographics
NPI:1346564739
Name:ELLA PERRY MEDICAL PC
Entity Type:Organization
Organization Name:ELLA PERRY MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETER
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSLYN
Authorized Official - Middle Name:L
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-882-1200
Mailing Address - Street 1:191 NORTH ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14201-1510
Mailing Address - Country:US
Mailing Address - Phone:716-882-1200
Mailing Address - Fax:716-882-1220
Practice Address - Street 1:191 NORTH ST
Practice Address - Street 2:SUITE 7
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14201-1510
Practice Address - Country:US
Practice Address - Phone:716-882-1200
Practice Address - Fax:716-882-1220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-15
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY210359261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1346564739OtherGROUP/ORGANIZATIONAL NPI
NYHO8962Medicare UPIN