Basic Information
| Provider Information | |||||||||
| NPI: | 1740504877 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OLEAN CARDIOLOGY P C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 908 NIAGARA FALLS BLVD | ||||||||
| Address2: | SUITE 208 | ||||||||
| City: | NORTH TONAWANDA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 141202019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166923302 | ||||||||
| FaxNumber: | 7163323525 | ||||||||
| Practice Location | |||||||||
| Address1: | 38 N MAIN ST - RT 16 | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | DELEVAN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 140429501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7167072112 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/18/2010 | ||||||||
| LastUpdateDate: | 03/18/2010 | ||||||||
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| AuthorizedOfficialLastName: | GUNAWARDANE | ||||||||
| AuthorizedOfficialFirstName: | CYRIL | ||||||||
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| AuthorizedOfficialTitleorPosition: | MD/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7167072112 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 171403 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.