Provider Demographics
NPI:1750347068
Name:CORASANTI, JAMES G (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:G
Last Name:CORASANTI
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
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:716-677-4414
Mailing Address - Fax:716-898-8805
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:716-677-4414
Practice Address - Fax:716-898-8805
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY158564-1207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01123422Medicaid
NY040426002075OtherFIDELIS
NY00010035802OtherUNIVERA
NY2499211OtherGHI
NY158564-5WOtherWORKERS COMPENSATION
NY1610005580OtherNORTH AMERICAN PREFERRED
NY2305467OtherIHA
NY161000580OtherEMPIRE
NYP00030104OtherRR MEDICARE
NY000503118008OtherHEALTH NOW
NY1610005580OtherNORTH AMERICAN PREFERRED
NY2499211OtherGHI