Elder Audio Rehab Medical Group Inc

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

FNP37597 Issued in CA

Legal business name

ELDER AUDIO REHAB MEDICAL GROUP INC

Practice address

4029 E Anaheim St
Long Beach, CA 90804-4110

Phone

(562) 494-4421

Fax

(562) 494-2731

NPI assigned

Sep 25, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Marshall Edward Blesofsky, PA-C

Title

Provider/Coo

Phone

(562) 760-8823

Specialties & licenses 2

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1222300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1297987200000",
    "number": "1871743856",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "65 PINE AVE",
            "address_2": "SUITE 119",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908024718",
            "telephone_number": "562-760-8823",
            "fax_number": "562-252-9505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4029 E ANAHEIM ST",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908044110",
            "telephone_number": "562-494-4421",
            "fax_number": "562-494-2731"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELDER AUDIO REHAB MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-25",
        "last_updated": "2011-02-18",
        "status": "A",
        "authorized_official_last_name": "BLESOFSKY",
        "authorized_official_first_name": "MARSHALL",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "PROVIDER/COO",
        "authorized_official_telephone_number": "562-760-8823",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Otolaryngology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "FNP37597",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leeann Ekstrom
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• Physician Assistant in Long Beach, CA
• Providers in Long Beach, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.