NPIMap

Organization Active NPI

Forest Medical Group, PLLC

  • Internal Medicine Physician
  • Williamsville, NY
National Provider Identifier
1215975289
Registry record updated Nov 5, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
188929-1 Issued in NY
Legal business name
FOREST MEDICAL GROUP, PLLC
Practice address
1360 N Forest Rd
Suite 3
Williamsville, NY 14221-1200
Phone
(716) 689-4800
Fax
(716) 689-4816
NPI assigned
Jun 3, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Richard F Divencenzo, M.D.
Title
Physician , Owner
Phone
(716) 689-4800

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X 188929-1 NY Primary

Addresses

Primary practice location

1360 N Forest Rd
Suite 3
Williamsville, NY 14221-1200

Mailing address

1360 N Forest Rd
Suite 3
Williamsville, NY 14221-1200
Phone (716) 689-4800

National Provider Directory

National Provider Directory

Locations

1360 N Forest Rd
Ste 3
Williamsville, NY 14221
Phone (716) 689-4800

1360 N Forest Rd
Ste 103
Williamsville, NY 14221
Phone (716) 689-4800

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149292800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1194220800000",
    "number": "1215975289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1360 N FOREST RD",
            "address_2": "SUITE 3",
            "city": "WILLIAMSVILLE",
            "state": "NY",
            "postal_code": "142211200",
            "telephone_number": "716-689-4800",
            "fax_number": "716-689-4816"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1360 N FOREST RD",
            "address_2": "SUITE 3",
            "city": "WILLIAMSVILLE",
            "state": "NY",
            "postal_code": "142211200",
            "telephone_number": "716-689-4800",
            "fax_number": "716-689-4816"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOREST MEDICAL GROUP, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-03",
        "last_updated": "2007-11-05",
        "status": "A",
        "authorized_official_last_name": "DIVENCENZO",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "PHYSICIAN , OWNER",
        "authorized_official_telephone_number": "716-689-4800",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "188929-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Williamsville, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.