Provider Demographics
NPI:1740388719
Name:ELDER MEDICAL SERVICES PC
Entity Type:Organization
Organization Name:ELDER MEDICAL SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:HOERNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-204-9710
Mailing Address - Street 1:132 CAYUGA RD
Mailing Address - Street 2:SUITE 1-C
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-1942
Mailing Address - Country:US
Mailing Address - Phone:716-204-9711
Mailing Address - Fax:716-204-9717
Practice Address - Street 1:132 CAYUGA RD
Practice Address - Street 2:SUITE 1-C
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-1942
Practice Address - Country:US
Practice Address - Phone:716-204-9711
Practice Address - Fax:716-204-9717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01693925Medicaid
NY11662AMedicare ID - Type Unspecified