Provider Demographics
NPI:1629492533
Name:BUFFALO-NIAGARA GASTROENTEROLOGY, PLLC
Entity Type:Organization
Organization Name:BUFFALO-NIAGARA GASTROENTEROLOGY, PLLC
Other - Org Name:BUFFALO-NIAGARA GASTROENTEROLOGY, PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:G
Authorized Official - Last Name:CORASANTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD PHD
Authorized Official - Phone:716-432-5393
Mailing Address - Street 1:5225 SHERIDAN DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-3573
Mailing Address - Country:US
Mailing Address - Phone:716-626-2644
Mailing Address - Fax:716-626-2660
Practice Address - Street 1:5225 SHERIDAN DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-3573
Practice Address - Country:US
Practice Address - Phone:716-626-2644
Practice Address - Fax:716-626-2660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-12
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY158564-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty