Provider Demographics
NPI:1215073762
Name:BURRUANO, MICHAEL P (DO)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:P
Last Name:BURRUANO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1456 ROUTE 22
Mailing Address - Street 2:SUITE A002
Mailing Address - City:BREWSTER
Mailing Address - State:NY
Mailing Address - Zip Code:10509-4348
Mailing Address - Country:US
Mailing Address - Phone:845-279-6222
Mailing Address - Fax:845-279-1055
Practice Address - Street 1:1456 ROUTE 22
Practice Address - Street 2:SUITE A002
Practice Address - City:BREWSTER
Practice Address - State:NY
Practice Address - Zip Code:10509-4348
Practice Address - Country:US
Practice Address - Phone:845-279-6222
Practice Address - Fax:845-279-1055
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY154811-1204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE49024Medicare UPIN