Provider Demographics
NPI:1548377583
Name:SIMMONS ORTHOPAEIDC & SPINE ASSOCIATES
Entity type:Organization
Organization Name:SIMMONS ORTHOPAEIDC & SPINE ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:C
Authorized Official - Last Name:MATTELIANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-882-0726
Mailing Address - Street 1:PO BOX 8000
Mailing Address - Street 2:DEPT. 839
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14267-0002
Mailing Address - Country:US
Mailing Address - Phone:716-882-3300
Mailing Address - Fax:716-882-3484
Practice Address - Street 1:235 NORTH ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14201-1401
Practice Address - Country:US
Practice Address - Phone:716-882-3300
Practice Address - Fax:716-882-3484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA1433Medicare ID - Type Unspecified