Provider Demographics
NPI:1790299832
Name:MEDICAL ECP OF WESTERN NEW YORK P C
Entity Type:Organization
Organization Name:MEDICAL ECP OF WESTERN NEW YORK P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:MERHIGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-245-3682
Mailing Address - Street 1:2697 LAKEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:NY
Mailing Address - Zip Code:14414-9767
Mailing Address - Country:US
Mailing Address - Phone:585-245-3682
Mailing Address - Fax:
Practice Address - Street 1:4330 MAPLE RD STE 102
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226
Practice Address - Country:US
Practice Address - Phone:585-245-3682
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-28
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY177166-1207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty