Provider Demographics
NPI:1912236811
Name:ION OLTEAN PHYSICIAN PC
Entity Type:Organization
Organization Name:ION OLTEAN PHYSICIAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ION
Authorized Official - Middle Name:
Authorized Official - Last Name:OLTEAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-631-0500
Mailing Address - Street 1:62 SEASONGOOD RD
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-6033
Mailing Address - Country:US
Mailing Address - Phone:718-631-0500
Mailing Address - Fax:718-281-1276
Practice Address - Street 1:139 66 35TH AVE
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11354
Practice Address - Country:US
Practice Address - Phone:718-963-3350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-24
Last Update Date:2009-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY218142207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH18454Medicare UPIN