1497398895 NPI number — ONEIDA HEALTH ROSWELL PARK ONCOLOGY LLC

Table of content: BRUCE LUNDIN OD LLC (NPI 1750336152)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497398895 NPI number — ONEIDA HEALTH ROSWELL PARK ONCOLOGY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ONEIDA HEALTH ROSWELL PARK ONCOLOGY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497398895
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/10/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
601 SENECA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ONEIDA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13421-2627
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-361-2351
Provider Business Mailing Address Fax Number:
315-361-2352

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 SENECA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ONEIDA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13421-2627
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-361-2351
Provider Business Practice Location Address Fax Number:
315-361-2352
Provider Enumeration Date:
10/18/2019

Additional Information

Authorized Official

Authorized Official Last Name:
PARRY
Authorized Official First Name:
MARY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT & AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
315-361-2045

Provider Taxonomy Codes

  • Taxonomy code: 261QX0203X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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