Healthcare Provider Details

I. General information

NPI: 1326138066
Provider Name (Legal Business Name): OLEAN MEDICAL GROUP PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 09/20/2021
Certification Date: 09/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6133 ROUTE 219 SUITE 1006
ELLICOTTVILLE NY
14731
US

IV. Provider business mailing address

6133 ROUTE 219 S STE 1006 SUITE 1006
ELLICOTTVILLE NY
14731-9613
US

V. Phone/Fax

Practice location:
  • Phone: 716-699-4332
  • Fax: 716-699-4307
Mailing address:
  • Phone: 716-699-4332
  • Fax: 716-699-4307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINE STRADE
Title or Position: CEO
Credential:
Phone: 716-372-0141