Provider Demographics
NPI:1508964693
Name:AQUINO, JOHN M (DPM)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:M
Last Name:AQUINO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2047 CLINTON STREET
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14206
Mailing Address - Country:US
Mailing Address - Phone:716-827-0100
Mailing Address - Fax:716-825-1381
Practice Address - Street 1:2047 CLINTON STREET
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14206
Practice Address - Country:US
Practice Address - Phone:716-827-0100
Practice Address - Fax:716-825-1381
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003211213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000500084005OtherBLUE CROSS
NY0544160001OtherNHIC DME MAC JURISDICTION
8903859OtherINDEPENDENT HEALTH
79081OtherGHI
00010250001OtherUNIRERA
480016754OtherMEDICARE RAILROAD
T25915Medicare UPIN
00010250001OtherUNIRERA
000847Medicare ID - Type Unspecified