Healthcare Provider Details

I. General information

NPI: 1508964693
Provider Name (Legal Business Name): JOHN M AQUINO DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2047 CLINTON STREET
BUFFALO NY
14206
US

IV. Provider business mailing address

2047 CLINTON STREET
BUFFALO NY
14206
US

V. Phone/Fax

Practice location:
  • Phone: 716-827-0100
  • Fax: 716-825-1381
Mailing address:
  • Phone: 716-827-0100
  • Fax: 716-825-1381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN003211
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: