Basic Information
| Provider Information | |||||||||
| NPI: | 1356523062 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BURRUANO | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 155 LAWN AVE | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142071816 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168752904 | ||||||||
| FaxNumber: | 7168756717 | ||||||||
| Practice Location | |||||||||
| Address1: | 155 LAWN AVE | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142071816 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168752904 | ||||||||
| FaxNumber: | 7168756717 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/04/2007 | ||||||||
| LastUpdateDate: | 11/17/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | N004668 | NY | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist |
ID Information
| ID | Type | State | Issuer | Description | 01198594 | 05 | NY | MEDICAID |