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General NPI Number Information
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NPI Number | 1629492533
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Entity Type | Organization
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Legal Business Name | BUFFALO-NIAGARA GASTROENTEROLOGY, PLLC
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Dates
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Enumeration Date | 02/12/2014
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Last Update Date | 12/15/2016
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Provider Practice Location Address
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Address Line | 5225 SHERIDAN DR
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-3573
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Country | US
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Telephone | 716-626-2644
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Fax | 716-626-2660
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Provider Business Mailing Address
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Address Line | 5225 SHERIDAN DR
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-3573
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Country | US
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Telephone | 716-626-2644
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Fax | 716-626-2660
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAMES G CORASANTI
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Credential | MD PHD
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Telephone | 716-432-5393
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 158564-1
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License Number State | NY
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