Provider Demographics
NPI:1457458671
Name:SOUTHTOWNS EAR, NOSE & THROAT, LLP
Entity Type:Organization
Organization Name:SOUTHTOWNS EAR, NOSE & THROAT, LLP
Other - Org Name:SOUTHTOWNS EAR, NOSE & THROAT, LLP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:C
Authorized Official - Last Name:GASS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-675-0616
Mailing Address - Street 1:3075 SOUTHWESTERN BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1236
Mailing Address - Country:US
Mailing Address - Phone:716-675-0616
Mailing Address - Fax:716-675-7101
Practice Address - Street 1:3075 SOUTHWESTERN BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1236
Practice Address - Country:US
Practice Address - Phone:716-675-0616
Practice Address - Fax:716-675-7101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA0561Medicare ID - Type UnspecifiedGROUP PROVIDER ID#