Provider Demographics
NPI:1740504877
Name:OLEAN CARDIOLOGY P C
Entity type:Organization
Organization Name:OLEAN CARDIOLOGY P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CYRIL
Authorized Official - Middle Name:
Authorized Official - Last Name:GUNAWARDANE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-707-2112
Mailing Address - Street 1:908 NIAGARA FALLS BLVD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-2019
Mailing Address - Country:US
Mailing Address - Phone:716-692-3302
Mailing Address - Fax:716-332-3525
Practice Address - Street 1:38 N MAIN ST - RT 16
Practice Address - Street 2:SUITE 2
Practice Address - City:DELEVAN
Practice Address - State:NY
Practice Address - Zip Code:14042-9501
Practice Address - Country:US
Practice Address - Phone:716-707-2112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-18
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171403207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty