Provider Demographics
NPI:1275715005
Name:MAIN GASTROENTEROLOGY. P.C.
Entity Type:Organization
Organization Name:MAIN GASTROENTEROLOGY. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ANONINO
Authorized Official - Middle Name:
Authorized Official - Last Name:MANONNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-632-3577
Mailing Address - Street 1:6637 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5974
Mailing Address - Country:US
Mailing Address - Phone:716-632-3576
Mailing Address - Fax:716-631-8275
Practice Address - Street 1:8201 MAIN ST. STE 4
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221
Practice Address - Country:US
Practice Address - Phone:716-632-3577
Practice Address - Fax:716-631-8275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY159226-1207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00801969Medicaid
NY00902098Medicaid
B36176Medicare UPIN
NY00801969Medicaid