Healthcare Provider Details

I. General information

NPI: 1508946377
Provider Name (Legal Business Name): WILLIAM F BUFFONE DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 01/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44210 ROUTE 48
SOUTHOLD NY
11971-0933
US

IV. Provider business mailing address

PO BOX 1146 44210 ROUTE 48
SOUTHOLD NY
11971-0933
US

V. Phone/Fax

Practice location:
  • Phone: 631-765-6777
  • Fax: 631-765-6933
Mailing address:
  • Phone: 631-765-6777
  • Fax: 631-765-6933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN0044431
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: