Provider Demographics
NPI:1346082476
Name:THRIVE MEDICAL WNY, P.C.
Entity type:Organization
Organization Name:THRIVE MEDICAL WNY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAITB
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:716-201-0410
Mailing Address - Street 1:536 POTOMAC AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14222-1129
Mailing Address - Country:US
Mailing Address - Phone:716-201-0410
Mailing Address - Fax:
Practice Address - Street 1:301 CONNECTICUT ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14213-2541
Practice Address - Country:US
Practice Address - Phone:716-201-0410
Practice Address - Fax:716-229-8146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-10
Last Update Date:2024-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service