Healthcare Provider Details

I. General information

NPI: 1821019050
Provider Name (Legal Business Name): ONTARIO MEDICAL PRACTICE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 05/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 W 6TH ST
OSWEGO NY
13126-2507
US

IV. Provider business mailing address

PO BOX 645
BUFFALO NY
14240-0645
US

V. Phone/Fax

Practice location:
  • Phone: 315-349-5511
  • Fax: 315-349-5785
Mailing address:
  • Phone: 315-349-5511
  • Fax: 315-349-5785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number StateNY

VIII. Authorized Official

Name: MR. ANN GILPIN
Title or Position: CFO
Credential:
Phone: 315-349-5511