1063400521 NPI number — ELIZABETH LOVE M.D.

Table of content: ELIZABETH LOVE M.D. (NPI 1063400521)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063400521 NPI number — ELIZABETH LOVE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOVE
Provider First Name:
ELIZABETH
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063400521
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/13/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2875 UNION RD
Provider Second Line Business Mailing Address:
SUITE 8
Provider Business Mailing Address City Name:
CHEEKTOWAGA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14227-1465
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-651-0911
Provider Business Mailing Address Fax Number:
716-651-9855

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6400 POWERS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORCHARD PARK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14127-4841
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-667-0001
Provider Business Practice Location Address Fax Number:
716-667-0028
Provider Enumeration Date:
10/10/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208100000X , with the licence number:  200473 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00010306305 . This is a "UNIVERA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 3000947 . This is a "IHA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 151124EL . This is a "PREFERRED CARE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 01761820 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10174010 . This is a "FIDELIS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000508352006 . This is a "BC/BS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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