Provider Demographics
NPI:1013086925
Name:OLEAN PODIATRY,P.C.
Entity Type:Organization
Organization Name:OLEAN PODIATRY,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:PUNEET
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHAHAL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:716-372-7396
Mailing Address - Street 1:2605 WEST STATE STREET
Mailing Address - Street 2:
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760
Mailing Address - Country:US
Mailing Address - Phone:716-372-7396
Mailing Address - Fax:716-372-1451
Practice Address - Street 1:2605 WEST STATE STREET
Practice Address - Street 2:
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760
Practice Address - Country:US
Practice Address - Phone:716-372-7396
Practice Address - Fax:716-372-1451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6263550001Medicare NSC
NY12242AMedicare PIN