Provider Demographics
NPI:1164613238
Name:MEDICAL ASSOCIATES SOUTHTOWNS, PC
Entity Type:Organization
Organization Name:MEDICAL ASSOCIATES SOUTHTOWNS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:P
Authorized Official - Last Name:ARMENIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-675-3754
Mailing Address - Street 1:300 CENTER RD
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-1946
Mailing Address - Country:US
Mailing Address - Phone:716-675-3754
Mailing Address - Fax:716-675-7110
Practice Address - Street 1:300 CENTER RD
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-1946
Practice Address - Country:US
Practice Address - Phone:716-675-3754
Practice Address - Fax:716-675-7110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY090890207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY055221OtherMEDICARE PROVIDER NUMBER