Provider Demographics
NPI:1346764461
Name:VENTURA, ELIJAH J (EMT)
Entity Type:Individual
Prefix:
First Name:ELIJAH
Middle Name:J
Last Name:VENTURA
Suffix:
Gender:M
Credentials:EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 SAGE AVE UPPR
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14210-1821
Mailing Address - Country:US
Mailing Address - Phone:716-946-3814
Mailing Address - Fax:
Practice Address - Street 1:71 SAGE AVE
Practice Address - Street 2:UPPER
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14210
Practice Address - Country:US
Practice Address - Phone:716-946-3814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-31
Last Update Date:2017-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY441044146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY441044OtherEMT