1720046253 NPI number — DR. MICHAEL D AQUINO DPM

Table of content: DR. MICHAEL D AQUINO DPM (NPI 1720046253)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720046253 NPI number — DR. MICHAEL D AQUINO DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AQUINO
Provider First Name:
MICHAEL
Provider Middle Name:
D
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720046253
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
929 BRIGHTON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TONAWANDA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14150-8113
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-837-1500
Provider Business Mailing Address Fax Number:
716-837-0799

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
564 NIAGARA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUFFALO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14201-1108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-884-1325
Provider Business Practice Location Address Fax Number:
716-837-0799
Provider Enumeration Date:
05/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  N003386 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00762881 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8903879 . This is a "INDEPENDENT HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000500064001 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00010250601 . This is a "UNIVERA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0079077 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 050110000141 . This is a "FIDELIS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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