Healthcare Provider Details

I. General information

NPI: 1619472719
Provider Name (Legal Business Name): RAPHA FAMILY MEDICAL WELLNESS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2018
Last Update Date: 06/17/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3610 MAIN STREET
AMHERST NY
14226
US

IV. Provider business mailing address

3610 MAIN ST
AMHERST NY
14226-3123
US

V. Phone/Fax

Practice location:
  • Phone: 716-833-4019
  • Fax: 716-783-8825
Mailing address:
  • Phone: 716-833-4019
  • Fax: 716-783-8825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number243530
License Number StateNY

VIII. Authorized Official

Name: DR. FRANCES E ILOZUE
Title or Position: PHYSICIAN
Credential: MD, MPH
Phone: 716-200-4122