Provider Demographics
NPI:1184729113
Name:OLTEAN, ION (MD)
Entity type:Individual
Prefix:
First Name:ION
Middle Name:
Last Name:OLTEAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4402 FRANCIS LEWIS BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-3041
Mailing Address - Country:US
Mailing Address - Phone:718-631-0500
Mailing Address - Fax:718-281-1276
Practice Address - Street 1:4402 FRANCIS LEWIS BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-3041
Practice Address - Country:US
Practice Address - Phone:718-631-0500
Practice Address - Fax:718-281-1276
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY218142207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02088080Medicaid
NY02088080Medicaid
NY07641LMedicare PIN
NY0271LXMedicare PIN
H18454Medicare UPIN