Healthcare Provider Details

I. General information

NPI: 1528992328
Provider Name (Legal Business Name): OSWEGO CARDIAC WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 STATE ROUTE 104 STE LL
OSWEGO NY
13126-2956
US

IV. Provider business mailing address

PO BOX 2046
OSWEGO NY
13126-0646
US

V. Phone/Fax

Practice location:
  • Phone: 315-342-4768
  • Fax: 315-342-4768
Mailing address:
  • Phone: 315-342-4768
  • Fax: 315-342-4768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL STEPHEN NUPUF
Title or Position: PRESIDENT
Credential: MD
Phone: 315-342-4768