Provider Demographics
NPI:1619072204
Name:FAMILY HEALTH MEDICAL SERVICES PLLC
Entity Type:Organization
Organization Name:FAMILY HEALTH MEDICAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BERKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-753-7107
Mailing Address - Street 1:103 ALLEN ST
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-6968
Mailing Address - Country:US
Mailing Address - Phone:716-338-0022
Mailing Address - Fax:716-338-1567
Practice Address - Street 1:103 ALLEN ST
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-6968
Practice Address - Country:US
Practice Address - Phone:716-338-0022
Practice Address - Fax:716-338-1567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYGRP512246001OtherBCBSWNY
NY02849278Medicaid
NY02849278Medicaid