Provider Demographics
NPI:1720598501
Name:SOM MEDICAL PRACTICE PLLC
Entity Type:Organization
Organization Name:SOM MEDICAL PRACTICE PLLC
Other - Org Name:NIAGARA FALLS URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SANTANU
Authorized Official - Middle Name:
Authorized Official - Last Name:SOM
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:516-661-5621
Mailing Address - Street 1:7332 ROCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-1628
Mailing Address - Country:US
Mailing Address - Phone:516-661-5621
Mailing Address - Fax:855-409-5577
Practice Address - Street 1:3117 MILITARY RD STE 1
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304-4813
Practice Address - Country:US
Practice Address - Phone:716-257-1254
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-05
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X, 261QM0801X
NY242962261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Single Specialty