Provider Demographics
NPI:1831223825
Name:ELLIOTT, GARY I (RPA-C)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:I
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3604 HORTON AVE
Mailing Address - Street 2:
Mailing Address - City:BLASDELL
Mailing Address - State:NY
Mailing Address - Zip Code:14219-2606
Mailing Address - Country:US
Mailing Address - Phone:716-823-8525
Mailing Address - Fax:
Practice Address - Street 1:1900 RIDGE RD
Practice Address - Street 2:HEALTHWIORKS WNY
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-3332
Practice Address - Country:US
Practice Address - Phone:716-712-0670
Practice Address - Fax:716-712-0674
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005415363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant