Healthcare Provider Details

I. General information

NPI: 1154387868
Provider Name (Legal Business Name): DONALD JOSEPH NENNO II MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 02/28/2020
Certification Date: 02/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 DELAWARE AVE
BUFFALO NY
14209-2412
US

IV. Provider business mailing address

468 DELAWARE AVENUE FLOOR 2
BUFFALO NY
14202
US

V. Phone/Fax

Practice location:
  • Phone: 716-883-4201
  • Fax: 716-883-4203
Mailing address:
  • Phone: 716-883-4201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number141376
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: