1609854702 NPI number — RADIATION THERAPY OF OLEAN PC

Table of content: (NPI 1609854702)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609854702 NPI number — RADIATION THERAPY OF OLEAN PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RADIATION THERAPY OF OLEAN PC
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:
6
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:
1609854702
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1415 BUFFALO ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OLEAN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14760-1139
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-373-7134
Provider Business Mailing Address Fax Number:
716-373-5787

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1415 BUFFALO ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OLEAN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14760-1139
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-373-7134
Provider Business Practice Location Address Fax Number:
716-373-5787
Provider Enumeration Date:
01/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DHALIWAL
Authorized Official First Name:
RANJIT
Authorized Official Middle Name:
S
Authorized Official Title or Position:
DELEGATED OFFICIAL
Authorized Official Telephone Number:
716-373-7134

Provider Taxonomy Codes

  • Taxonomy code: 2085R0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 952634 . This is a "HIGHMARK BC/BS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 01289849 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000528169001 . This is a "BC OF WESTERN NY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0012714830001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000528169001 . This is a "COMMUNITY BLUE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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