# FOREST MEDICAL GROUP, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1215975289
- **Authorized official:** RICHARD F DIVENCENZO M.D. (PHYSICIAN , OWNER)
- **Authorized official phone:** (716) 689-4800

## Contact information

- **Practice address:** 1360 N FOREST RD, SUITE 3, WILLIAMSVILLE, NY 14221-1200
- **Practice address phone:** (716) 689-4800
- **Practice address fax:** (716) 689-4816
- **Mailing address:** 1360 N FOREST RD, SUITE 3, WILLIAMSVILLE, NY 14221-1200
- **Mailing address phone:** (716) 689-4800
- **Mailing address fax:** (716) 689-4816

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | 188929-1 | NY | Yes |

## Other

- **Enumeration date:** 06/03/2006
- **Last updated:** 11/05/2007