Provider Demographics
NPI:1437406931
Name:LAKE ERIE MEDICAL SERVICES, PC
Entity Type:Organization
Organization Name:LAKE ERIE MEDICAL SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:HASSENFRATZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:716-672-2000
Mailing Address - Street 1:268 W MAIN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:FREDONIA
Mailing Address - State:NY
Mailing Address - Zip Code:14063-2200
Mailing Address - Country:US
Mailing Address - Phone:716-672-2000
Mailing Address - Fax:716-672-4414
Practice Address - Street 1:268 W MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:FREDONIA
Practice Address - State:NY
Practice Address - Zip Code:14063-2200
Practice Address - Country:US
Practice Address - Phone:716-672-2000
Practice Address - Fax:716-672-4414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-14
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1942462940207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ100079531Medicare UPIN