Provider Demographics
NPI:1871706721
Name:FINGER LAKES EMERGENCY PHYSICIAN SERVICES PLLC
Entity type:Organization
Organization Name:FINGER LAKES EMERGENCY PHYSICIAN SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:C JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:585-225-9230
Mailing Address - Street 1:345 COUNTRY WOODS LN
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-4701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2300 BUFFALO RD
Practice Address - Street 2:BLDG # 900
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-1360
Practice Address - Country:US
Practice Address - Phone:585-426-4990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1913411207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty