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General NPI Number Information
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NPI Number | 1295779072
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Entity Type | Organization
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Legal Business Name | SOUTHTOWNS RADIOLOGY ASSOCIATES, LLC
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Dates
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Enumeration Date | 06/15/2006
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Last Update Date | 12/09/2014
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Provider Practice Location Address
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Address Line | 3040 AMSDELL RD
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City | HAMBURG
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State | NY
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Zip | 14075-5835
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Country | US
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Telephone | 716-649-9000
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Fax | 716-649-9005
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Provider Business Mailing Address
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Address Line | 3040 AMSDELL RD
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City | HAMBURG
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State | NY
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Zip | 14075-5835
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Country | US
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Telephone | 716-649-9000
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Fax | 716-649-9005
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Authorized Official
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Title or Position | DELEGATED OFFICAL
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Name | EDITH R HAIER
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Credential |
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Telephone | 716-649-9000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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