Healthcare Provider Details

I. General information

NPI: 1609854702
Provider Name (Legal Business Name): RADIATION THERAPY OF OLEAN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 BUFFALO ST
OLEAN NY
14760-1139
US

IV. Provider business mailing address

1415 BUFFALO ST
OLEAN NY
14760-1139
US

V. Phone/Fax

Practice location:
  • Phone: 716-373-7134
  • Fax: 716-373-5787
Mailing address:
  • Phone: 716-373-7134
  • Fax: 716-373-5787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier952634
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerHIGHMARK BC/BS
# 2
Identifier01289849
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer
# 3
Identifier000528169001
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerBC OF WESTERN NY
# 4
Identifier0012714830001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 5
Identifier000528169001
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerCOMMUNITY BLUE

VIII. Authorized Official

Name: RANJIT S DHALIWAL
Title or Position: DELEGATED OFFICIAL
Credential: M.D.
Phone: 716-373-7134