Healthcare Provider Details

I. General information

NPI: 1225085053
Provider Name (Legal Business Name): FAMILY CARE PHYSICIAN, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 02/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 MAPLE RD
WILLIAMSVILLE NY
14221-2918
US

IV. Provider business mailing address

61 MAPLE RD
WILLIAMSVILLE NY
14221-2918
US

V. Phone/Fax

Practice location:
  • Phone: 716-565-1234
  • Fax: 716-565-1246
Mailing address:
  • Phone: 716-565-1234
  • Fax: 716-565-1246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number191531-1
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: VITO D PALUMBO
Title or Position: PRESIDENT
Credential: D.O.
Phone: 716-565-1234