Healthcare Provider Details

I. General information

NPI: 1760843056
Provider Name (Legal Business Name): SOUTHTOWNS AMBULATORY ANESTHESIA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2016
Last Update Date: 03/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5959 BIG TREE RD
ORCHARD PARK NY
14127-2291
US

IV. Provider business mailing address

56 GRAND VIEW TRL
ORCHARD PARK NY
14127-3756
US

V. Phone/Fax

Practice location:
  • Phone: 716-984-7840
  • Fax:
Mailing address:
  • Phone: 716-984-7840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: DR. ED PLATA
Title or Position: PHYSICIAN
Credential: MD
Phone: 716-984-7840