Provider Demographics
NPI:1407863509
Name:WESTERN NEW YORK RADIATION ONCOLOGY
Entity Type:Organization
Organization Name:WESTERN NEW YORK RADIATION ONCOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:NORLUND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-677-5100
Mailing Address - Street 1:550 ORCHARD PARK RD
Mailing Address - Street 2:A100
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-2646
Mailing Address - Country:US
Mailing Address - Phone:716-677-5100
Mailing Address - Fax:716-677-5108
Practice Address - Street 1:550 ORCHARD PARK RD
Practice Address - Street 2:A100
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-2646
Practice Address - Country:US
Practice Address - Phone:716-677-5100
Practice Address - Fax:716-677-5108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02744338Medicaid
NYBA0859Medicare ID - Type Unspecified