Provider Demographics
NPI:1306894522
Name:SOUTH TOWNS SURGICAL ASSOCIATES P.C.
Entity type:Organization
Organization Name:SOUTH TOWNS SURGICAL ASSOCIATES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:716-675-7730
Mailing Address - Street 1:310 STERLING DRIVE SUITE 105
Mailing Address - Street 2:SOUTH TOWNS SURGICAL ASSOCIATES, P.C.
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127
Mailing Address - Country:US
Mailing Address - Phone:716-675-7730
Mailing Address - Fax:716-675-7735
Practice Address - Street 1:310 STERLING DRIVE
Practice Address - Street 2:SUITE 105
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127
Practice Address - Country:US
Practice Address - Phone:716-675-7730
Practice Address - Fax:716-675-7735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208600000X
NY170358208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJXXMedicaid