=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164728226
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUTHTOWNS RADIATION ONCOLOGY, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/07/2011
-----------------------------------------------------
Last Update Date | 02/07/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 550 ORCHARD PARK RD SUITE A100
-----------------------------------------------------
City | WEST SENECA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14224-2646
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-674-6800
-----------------------------------------------------
Fax | 716-674-6804
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 550 ORCHARD PARK RD SUITE A100
-----------------------------------------------------
City | WEST SENECA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14224-2646
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-674-6800
-----------------------------------------------------
Fax | 716-674-6804
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. STEVEN J. GREGORITCH
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 716-674-6800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0001X
-----------------------------------------------------
Taxonomy Name | Radiation Oncology Physician
-----------------------------------------------------
License Number | 171770-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------