1619472719 NPI number — RAPHA FAMILY MEDICAL WELLNESS PC

Table of content: (NPI 1619472719)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619472719 NPI number — RAPHA FAMILY MEDICAL WELLNESS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RAPHA FAMILY MEDICAL WELLNESS PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619472719
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/17/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3610 MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AMHERST
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14226-3123
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-833-4019
Provider Business Mailing Address Fax Number:
716-783-8825

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3610 MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AMHERST
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14226
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-833-4019
Provider Business Practice Location Address Fax Number:
716-783-8825
Provider Enumeration Date:
03/29/2018

Additional Information

Authorized Official

Authorized Official Last Name:
ILOZUE
Authorized Official First Name:
FRANCES
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
716-200-4122

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  243530 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com