Healthcare Provider Details

I. General information

NPI: 1255146726
Provider Name (Legal Business Name): THRIVE FAMILY MEDICINE WNY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2025
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 CONNECTICUT ST FL 2
BUFFALO NY
14213-2541
US

IV. Provider business mailing address

4714 LOWER RIVER RD
LEWISTON NY
14092-1053
US

V. Phone/Fax

Practice location:
  • Phone: 716-923-4617
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DAVID KHATIB
Title or Position: DIRECTOR
Credential: DO
Phone: 716-535-6939