Healthcare Provider Details

I. General information

NPI: 1649884263
Provider Name (Legal Business Name): URBAN FAMILY PRACTICE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2020
Last Update Date: 09/01/2020
Certification Date: 09/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

564 NIAGARA ST
BUFFALO NY
14201-1108
US

IV. Provider business mailing address

564 NIAGARA ST
BUFFALO NY
14201-1108
US

V. Phone/Fax

Practice location:
  • Phone: 716-882-0366
  • Fax: 716-884-8096
Mailing address:
  • Phone: 716-882-0366
  • Fax: 716-884-8096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: EVA PEREZ
Title or Position: BILLING PROJECT MANAGER
Credential:
Phone: 716-445-1932