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General NPI Number Information
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NPI Number | 1518041342
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Entity Type | Organization
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Legal Business Name | JAMESTOWN MEDICAL ONCOLOGY HEMATOLOGY, LLC
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 21 PORTER AVE
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City | JAMESTOWN
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State | NY
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Zip | 14701-6247
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Country | US
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Telephone | 716-664-1909
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Fax | 716-664-2214
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Provider Business Mailing Address
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Address Line | PO BOX 9
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City | JAMESTOWN
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State | NY
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Zip | 14702-0009
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Country | US
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Telephone | 716-664-1909
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Fax | 716-664-2214
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MRS. SUSAN GABUTEN IBABAO
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Credential |
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Telephone | 716-664-1909
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QX0200X
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Taxonomy Name | Oncology Clinic/Center
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License Number |
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License Number State | NY
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