Basic Information
| Provider Information | |||||||||
| NPI: | 1063817179 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BUFFALO-NIAGARA GASTROENTEROLOGY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5225 SHERIDAN DR | ||||||||
| Address2: | |||||||||
| City: | WILLIAMSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142213573 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166262644 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5225 SHERIDAN DR | ||||||||
| Address2: | |||||||||
| City: | WILLIAMSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142213573 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166262644 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2014 | ||||||||
| LastUpdateDate: | 10/31/2014 | ||||||||
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| AuthorizedOfficialLastName: | CORASANTI | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7166262644 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 339251 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.