Individual provider Active NPI

Lisa A Durandetto, NP

  • Adult Health Nurse Practitioner
  • Williamsville, NY
National Provider Identifier
1366408775
Registry record updated Feb 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
F304142 Issued in NY
Practice address
325 Essjay Rd
Williamsville, NY 14221-8243
Phone
(716) 630-1146
Fax
(716) 817-1727
NPI assigned
Apr 25, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 14, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X F304142 NY Primary

Addresses

Primary practice location

325 Essjay Rd
Williamsville, NY 14221-8243

Mailing address

425 Essjay Rd Ste 170
Williamsville, NY 14221-8235
Phone (716) 630-1219

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050601000570 NY Practitioner - Nurse Practitioner 1153363098 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
F304142NYMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
General Physician, PC CurrentSince Feb 29, 2016 Accepting new patients
Buffalo Medical Group, P.C. CurrentSince Apr 1, 2005 Accepting new patients
Buffalo Medical Group, P.C. CurrentSince Apr 1, 2005 Accepting new patients

Locations

85 High St
Buffalo, NY 14203
Phone (716) 857-8623

3898 Vineyard Dr
Dunkirk, NY 14048
Phone (716) 363-1515

277 Division St
North Tonawanda, NY 14120
Phone (716) 260-1159

425 Essjay Rd
Ste 170
Williamsville, NY 14221
Phone (716) 630-1219

325 Essjay Rd
Williamsville, NY 14221
Phone (716) 630-1102

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1145923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581638400000",
    "number": "1366408775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 ESSJAY RD STE 170",
            "city": "WILLIAMSVILLE",
            "state": "NY",
            "postal_code": "142218235",
            "telephone_number": "716-630-1219",
            "fax_number": "716-817-1726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 ESSJAY RD",
            "city": "WILLIAMSVILLE",
            "state": "NY",
            "postal_code": "142218243",
            "telephone_number": "716-630-1146",
            "fax_number": "716-817-1727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DURANDETTO",
        "first_name": "LISA",
        "middle_name": "A",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-25",
        "last_updated": "2020-02-14",
        "certification_date": "2020-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "F304142",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Williamsville, NY

Sources for this page

Verify at the official NPI Registry.