Provider Demographics
NPI:1154387868
Name:NENNO, DONALD JOSEPH II (MD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:JOSEPH
Last Name:NENNO
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:468 DELAWARE AVENUE
Mailing Address - Street 2:FLOOR 2
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14202
Mailing Address - Country:US
Mailing Address - Phone:716-883-4201
Mailing Address - Fax:
Practice Address - Street 1:1275 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14209-2412
Practice Address - Country:US
Practice Address - Phone:716-883-4201
Practice Address - Fax:716-883-4203
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY141376204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00480979Medicaid
NY080165Medicare ID - Type Unspecified
NY00480979Medicaid