Healthcare Provider Details

I. General information

NPI: 1710941521
Provider Name (Legal Business Name): NICHOLAS JAMES AQUINO M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 08/05/2022
Certification Date: 08/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 MAIN ST
BUFFALO NY
14203-1009
US

IV. Provider business mailing address

3085 HARLEM RD STE 350
CHEEKTOWAGA NY
14225-2591
US

V. Phone/Fax

Practice location:
  • Phone: 716-859-7978
  • Fax: 716-859-1295
Mailing address:
  • Phone: 716-844-5600
  • Fax: 716-844-5750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number159107
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number159107
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number159107
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: