Provider Demographics
NPI:1619472719
Name:RAPHA FAMILY MEDICAL WELLNESS PC
Entity Type:Organization
Organization Name:RAPHA FAMILY MEDICAL WELLNESS PC
Other - Org Name:RAPHA FAMILY WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANCES
Authorized Official - Middle Name:E
Authorized Official - Last Name:ILOZUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-833-4019
Mailing Address - Street 1:3610 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-3123
Mailing Address - Country:US
Mailing Address - Phone:716-833-4019
Mailing Address - Fax:716-783-8825
Practice Address - Street 1:3610 MAIN STREET
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226
Practice Address - Country:US
Practice Address - Phone:716-833-4019
Practice Address - Fax:716-783-8825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-29
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY243530207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty