Provider Demographics
NPI:1063490837
Name:PODIATRY SURGEON OF WNY PC
Entity Type:Organization
Organization Name:PODIATRY SURGEON OF WNY PC
Other - Org Name:DR JAMES BURRUANO DPM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PODIATRIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:BURRUANO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:716-874-5540
Mailing Address - Street 1:80 DELAWARE RD
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:NY
Mailing Address - Zip Code:14217
Mailing Address - Country:US
Mailing Address - Phone:716-874-5540
Mailing Address - Fax:716-874-0696
Practice Address - Street 1:80 DELAWARE RD
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:NY
Practice Address - Zip Code:14217
Practice Address - Country:US
Practice Address - Phone:716-874-5540
Practice Address - Fax:716-874-0696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-03
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004668213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBA0640Medicare PIN
NY5489500001Medicare NSC