Provider Demographics
NPI:1770561888
Name:RANJIT S DHALIWAL, PHY, PLLC
Entity type:Organization
Organization Name:RANJIT S DHALIWAL, PHY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RANJIT
Authorized Official - Middle Name:S
Authorized Official - Last Name:DHALIWAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:607-324-0061
Mailing Address - Street 1:4237 BUFFALO RD
Mailing Address - Street 2:104
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16510-2111
Mailing Address - Country:US
Mailing Address - Phone:814-790-5611
Mailing Address - Fax:814-480-5755
Practice Address - Street 1:21 ORCHARD ST
Practice Address - Street 2:
Practice Address - City:HORNELL
Practice Address - State:NY
Practice Address - Zip Code:14843-2111
Practice Address - Country:US
Practice Address - Phone:607-324-0061
Practice Address - Fax:607-324-7547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-09
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000161343OtherEXCELLUS
NYP020182137OtherBC OF ROCHESTER
NY000525190002OtherBC OF WESTERN NY
NY01123380Medicaid
NYP020182137OtherBC OF ROCHESTER