Organization Active NPI

Southtowns Neurology of Western New York PC

  • Specialist
  • West Seneca, NY
National Provider Identifier
1346446614
Registry record updated Oct 13, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
206950 Issued in NY
Legal business name
SOUTHTOWNS NEUROLOGY OF WESTERN NEW YORK PC
Practice address
3775 Seneca St
West Seneca, NY 14224-3434
Phone
(716) 712-0890
Fax
(716) 712-0933
NPI assigned
Jun 25, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Peterkin Leekwen, M.D.NPI 1811966880
Title
Ceo
Phone
(716) 712-0890

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X 206950 NY Primary

Addresses

Primary practice location

3775 Seneca St
West Seneca, NY 14224-3434

Mailing address

3775 Seneca St
West Seneca, NY 14224-3434
Phone (716) 712-0890

Other identifiers 1

IdentifierTypeStateIssuer
02731060MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060317000095 NY Part B Supplier - Clinic/Group Practice 9931116894 Receives reassigned benefits from 4 practitioners
Practice locations: Silver Creek, NY; West Seneca, NY

National Provider Directory

National Provider Directory

Locations

849 Route 5 and 20
#5
Irving, NY 14081
Phone (716) 646-0970

12655 Seneca Rd
Irving, NY 14081
Phone (716) 517-5069

327 Central Ave
Silver Creek, NY 14136
Phone (716) 712-0890

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1182729600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1444694400000",
    "number": "1346446614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3775 SENECA ST",
            "city": "WEST SENECA",
            "state": "NY",
            "postal_code": "142243434",
            "telephone_number": "716-712-0890",
            "fax_number": "716-712-0933"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3775 SENECA ST",
            "city": "WEST SENECA",
            "state": "NY",
            "postal_code": "142243434",
            "telephone_number": "716-712-0890",
            "fax_number": "716-712-0933"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHTOWNS NEUROLOGY OF WESTERN NEW YORK PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-25",
        "last_updated": "2015-10-13",
        "status": "A",
        "authorized_official_last_name": "LEEKWEN",
        "authorized_official_first_name": "PETERKIN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "716-712-0890",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "NY",
            "license": "206950",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02731060",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in West Seneca, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.