Basic Information
| Provider Information | |||||||||
| NPI: | 1962538637 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTHTOWN RADIOLOGY ASSOCIATES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 565 ABBOTT RD | ||||||||
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| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142202039 | ||||||||
| CountryCode: | US | ||||||||
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| Address1: | 565 ABBOTT RD | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142202039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168282399 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2007 | ||||||||
| LastUpdateDate: | 08/23/2007 | ||||||||
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| AuthorizedOfficialLastName: | LLUGANY | ||||||||
| AuthorizedOfficialFirstName: | OSCAR | ||||||||
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| AuthorizedOfficialTitleorPosition: | AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 7168282399 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.