Provider Demographics
NPI:1225059678
Name:BURRUANO, BRIDGET (PA)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:
Last Name:BURRUANO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 S UNION RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-6509
Mailing Address - Country:US
Mailing Address - Phone:716-632-5200
Mailing Address - Fax:716-632-5201
Practice Address - Street 1:52 S UNION RD
Practice Address - Street 2:SUITE 203
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-6509
Practice Address - Country:US
Practice Address - Phone:716-632-5200
Practice Address - Fax:716-632-5201
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005706363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02345595Medicaid
NY9512139OtherINDEPENDENT HEALTH
NY061108000004OtherFIDELIS CARE
NY139378BFOtherPREFERRED CARE
NY00021043502OtherUNIVERA
NY000570178004OtherBCBS
NY02345595Medicaid
PA2596Medicare PIN
PA1418Medicare PIN