Healthcare Provider Details

I. General information

NPI: 1962538637
Provider Name (Legal Business Name): SOUTHTOWN RADIOLOGY ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 08/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

565 ABBOTT RD
BUFFALO NY
14220-2039
US

IV. Provider business mailing address

565 ABBOTT RD
BUFFALO NY
14220-2039
US

V. Phone/Fax

Practice location:
  • Phone: 716-828-2399
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: OSCAR LLUGANY
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 716-828-2399