Provider Demographics
NPI:1639634900
Name:ONEIDA HEALTH ROSWELL PARK ONCOLOGY LLC
Entity Type:Organization
Organization Name:ONEIDA HEALTH ROSWELL PARK ONCOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & AUTHORIZED OFFICIAL
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:PARRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-361-2045
Mailing Address - Street 1:601 SENECA ST
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:NY
Mailing Address - Zip Code:13421-2627
Mailing Address - Country:US
Mailing Address - Phone:315-361-2351
Mailing Address - Fax:315-361-2352
Practice Address - Street 1:601 SENECA ST
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:NY
Practice Address - Zip Code:13421
Practice Address - Country:US
Practice Address - Phone:315-361-2351
Practice Address - Fax:315-361-2352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-31
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty