Organization
ELITE MEDICAL SUPPLY
Active
Organization
ELITE MEDICAL SUPPLY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GARY ANTHONY NIKIEL (OWNER)
(716) 712-0881
Entity
Organization
Contact information
Practice address
1900 RIDGE RD, WEST SENECA, NY 14224-3332
(716) 712-0881
(716) 712-0882
Mailing address
1900 RIDGE RD, WEST SENECA, NY 14224-3332
(716) 712-0881
(716) 712-0882
Taxonomy
Speciality
Code
Description
License number
State
225000000X
Orthotic Fitter
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000551490001
BLUE CROSS BLUE SHIELD
—
05
—
02752078
—
NY
01
—
8290875
INDEPENDENT HEALTH
—
Enumeration date
01/05/2006
Last updated
09/27/2007
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