Provider Demographics
NPI:1851509186
Name:URBAN WOMEN'S MEDICAL, P.C.
Entity Type:Organization
Organization Name:URBAN WOMEN'S MEDICAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:DEVERE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-835-7737
Mailing Address - Street 1:3580 SHERIDAN DR
Mailing Address - Street 2:SUITE 130
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-1645
Mailing Address - Country:US
Mailing Address - Phone:716-835-7737
Mailing Address - Fax:716-835-3733
Practice Address - Street 1:3580 SHERIDAN DR
Practice Address - Street 2:SUITE 130
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-1645
Practice Address - Country:US
Practice Address - Phone:716-835-7737
Practice Address - Fax:716-835-3733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY197364207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY040426002348OtherFIDELIS
NY01760278Medicaid
NY0710873OtherIHA - NOT ACTIVE
NY00010044603OtherUNIVERA - NOT ACTIVE
NY0298887OtherGHI
NY0298887OtherGHI
NYAA0773Medicare ID - Type Unspecified