Provider Demographics
NPI:1760419162
Name:LEMLEY, ELAINE (PA)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:LEMLEY
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 1:6227 E BETHANY LEROY RD
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14143-9562
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3 TOUNTAS AVE
Practice Address - Street 2:
Practice Address - City:LE ROY
Practice Address - State:NY
Practice Address - Zip Code:14482
Practice Address - Country:US
Practice Address - Phone:585-768-6530
Practice Address - Fax:585-768-4593
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002758-1363AM0700X
363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPA0968Medicare PIN