Provider Demographics
NPI:1124119029
Name:KENMORE FAMILY MEDICINE, LLP
Entity type:Organization
Organization Name:KENMORE FAMILY MEDICINE, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:SILVERSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-875-6700
Mailing Address - Street 1:2914 ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:NY
Mailing Address - Zip Code:14217-1332
Mailing Address - Country:US
Mailing Address - Phone:716-875-6700
Mailing Address - Fax:716-875-6853
Practice Address - Street 1:2914 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:NY
Practice Address - Zip Code:14217-1332
Practice Address - Country:US
Practice Address - Phone:716-875-6700
Practice Address - Fax:716-875-6853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1043503246OtherNPI
NYS66570Medicare UPIN
NY12102AMedicare PIN
NYBB8384Medicare UPIN
NYH22178Medicare UPIN
NY1043503246OtherNPI
NYB35927Medicare UPIN