MEDICARE: MEDICAL LABORATORY OF OLEAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory	PFI3746	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PFI3746	OTHER	NY	STATE LICENSE NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962495812
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL LABORATORY OF OLEAN

Provider Business Mailing Address
First Line	:	2626 W STATE ST
Second Line	:
City	:	OLEAN
State	:	NY
Zip	:	14760-1858
Country	:	US
Telephone Number	:	716-373-2670
Fax Number	:	716-373-2673

Provider Business Practice Location Address
First Line	:	2626 W STATE ST
Second Line	:
City	:	OLEAN
State	:	NY
Zip	:	14760-1858
Country	:	US
Telephone Number	:	716-373-2670
Fax Number	:	716-373-2673

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BABU A BHAWSAR
Credential	:	MA
Telephone Number	:	716-373-2670

Provider Enumeration Date	:	08/25/2005
Last Update Date	:	08/22/2020

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