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General NPI Number Information
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NPI Number | 1821019050
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Entity Type | Organization
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Legal Business Name | ONTARIO MEDICAL PRACTICE PC
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Dates
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Enumeration Date | 07/22/2006
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Last Update Date | 05/23/2008
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Provider Practice Location Address
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Address Line | 110 W 6TH ST
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City | OSWEGO
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State | NY
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Zip | 13126-2507
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Country | US
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Telephone | 315-349-5511
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Fax | 315-349-5785
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Provider Business Mailing Address
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Address Line | PO BOX 645
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City | BUFFALO
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State | NY
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Zip | 14240-0645
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Country | US
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Telephone | 315-349-5511
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Fax | 315-349-5785
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Authorized Official
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Title or Position | CFO
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Name | MR. ANN GILPIN
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Credential |
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Telephone | 315-349-5511
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number |
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State | NY
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