Provider Demographics
NPI:1134564164
Name:EASTERN FINGER LAKES EMERGENCY MEDICAL CARE, PLLC
Entity type:Organization
Organization Name:EASTERN FINGER LAKES EMERGENCY MEDICAL CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PATST
Authorized Official - Middle Name:
Authorized Official - Last Name:IANNOLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-458-9525
Mailing Address - Street 1:PO BOX 200
Mailing Address - Street 2:
Mailing Address - City:NEW YORK MILLS
Mailing Address - State:NY
Mailing Address - Zip Code:13417-0200
Mailing Address - Country:US
Mailing Address - Phone:315-458-9525
Mailing Address - Fax:315-458-9629
Practice Address - Street 1:17 LANSING ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-1983
Practice Address - Country:US
Practice Address - Phone:315-458-9525
Practice Address - Fax:315-458-9629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-03
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY155664207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty