Healthcare Provider Details

I. General information

NPI: 1760781330
Provider Name (Legal Business Name): JOHN BURKE ORTOLANI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HIGH ST
BUFFALO NY
14203-1126
US

IV. Provider business mailing address

846 MAIN ST APT 2I
BUFFALO NY
14202-1442
US

V. Phone/Fax

Practice location:
  • Phone: 716-859-7330
  • Fax:
Mailing address:
  • Phone: 716-553-9983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number289134
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: