MEDICARE: URBAN FAMILY PRACTICE PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician
2	363L00000X	Nurse Practitioner
3	207Q00000X	Family Medicine Physician
4	363LF0000X	Family Nurse Practitioner	F332631	NY
5	207PT0002X	Medical Toxicology (Emergency Medicine) Physician	1850521NYS	NY
6	253Z00000X	In Home Supportive Care Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00030011001	OTHER		UNIVERA HEALTH
2	005115189	OTHER	NY	BCBS COMM BLUE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	0108003	OTHER		INDEPENDENT HEALTH

General Provider Information

NPI Number	:	1164594099
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	URBAN FAMILY PRACTICE PC

Provider Business Mailing Address
First Line	:	564 NIAGARA ST BLDG 2
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14201-1108
Country	:	US
Telephone Number	:	716-882-0366
Fax Number	:	716-306-4177

Provider Business Practice Location Address
First Line	:	564 NIAGARA STREET
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14201
Country	:	US
Telephone Number	:	716-882-0366
Fax Number	:	716-884-8096

Authorized Official
Title or Position	:	SENIOR DIRECTOR
Name	:	MR. KANE D BACH-REYES
Credential	:	CPCS
Telephone Number	:	917-514-3188

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	04/23/2026

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Directions to “URBAN FAMILY PRACTICE PC ” Practice Location

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