Provider Demographics
NPI:1568412450
Name:NIAGARA FAMILY MEDICINE ASSOCIATES,PC
Entity Type:Organization
Organization Name:NIAGARA FAMILY MEDICINE ASSOCIATES,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:C
Authorized Official - Last Name:ANDRES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-298-5862
Mailing Address - Street 1:7300 PORTER RD
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14304-5705
Mailing Address - Country:US
Mailing Address - Phone:716-298-5862
Mailing Address - Fax:716-285-3622
Practice Address - Street 1:7300 PORTER RD
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304-5705
Practice Address - Country:US
Practice Address - Phone:716-298-5862
Practice Address - Fax:716-285-3622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY150366207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02533360Medicaid
NY5997588OtherGHI
NY00030588601OtherUNIVERA
NYAA1615Medicare ID - Type UnspecifiedGROUP ID NUMBER