Provider Demographics
NPI:1063400521
Name:LOVE, ELIZABETH (MD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:LOVE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2875 UNION RD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14227-1465
Mailing Address - Country:US
Mailing Address - Phone:716-651-0911
Mailing Address - Fax:716-651-9855
Practice Address - Street 1:6400 POWERS RD
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-4841
Practice Address - Country:US
Practice Address - Phone:716-667-0001
Practice Address - Fax:716-667-0028
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY200473208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00010306305OtherUNIVERA
NY3000947OtherIHA
NE151124ELOtherPREFERRED CARE
NY01761820Medicaid
NY10174010OtherFIDELIS
NY000508352006OtherBC/BS
NY00010306305OtherUNIVERA
NY01761820Medicaid
DF2786Medicare PIN
RB0888Medicare PIN