Provider Demographics
NPI:1053405241
Name:EXTENDED MEDICAL SERVICES, PLLC
Entity type:Organization
Organization Name:EXTENDED MEDICAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUNEEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:KOUL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-305-0615
Mailing Address - Street 1:1024 HILTON PARMA CORNERS RD
Mailing Address - Street 2:
Mailing Address - City:HILTON
Mailing Address - State:NY
Mailing Address - Zip Code:14468-9328
Mailing Address - Country:US
Mailing Address - Phone:585-392-4114
Mailing Address - Fax:585-392-5226
Practice Address - Street 1:1024 HILTON PARMA CORNERS RD
Practice Address - Street 2:
Practice Address - City:HILTON
Practice Address - State:NY
Practice Address - Zip Code:14468-9328
Practice Address - Country:US
Practice Address - Phone:585-392-4114
Practice Address - Fax:585-392-5226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01852280Medicaid
NYBA1422Medicare PIN
NYG61600Medicare UPIN