Provider Demographics
NPI:1417436296
Name:EININK, KAELI (PA)
Entity Type:Individual
Prefix:MS
First Name:KAELI
Middle Name:
Last Name:EININK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14787-0010
Mailing Address - Country:US
Mailing Address - Phone:716-326-4678
Mailing Address - Fax:716-326-4914
Practice Address - Street 1:115 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:NY
Practice Address - Zip Code:14781-8002
Practice Address - Country:US
Practice Address - Phone:716-761-6144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-13
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022456363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant