1467430447 NPI number — NORTH SHORE HEMATOLOGY/ONCOLOGY ASSOCIATES PC

Table of content: (NPI 1467430447)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467430447 NPI number — NORTH SHORE HEMATOLOGY/ONCOLOGY ASSOCIATES PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH SHORE HEMATOLOGY/ONCOLOGY ASSOCIATES PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CPHO A DIVISION OF NY CANCER & BLOOD SPECIALISTS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467430447
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/31/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12 E 86TH ST
Provider Second Line Business Mailing Address:
OFC 4
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10028-0506
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-861-6660
Provider Business Mailing Address Fax Number:
212-744-4696

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12 E 86TH ST
Provider Second Line Business Practice Location Address:
OFC 4
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10028-0506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-861-6660
Provider Business Practice Location Address Fax Number:
212-744-4696
Provider Enumeration Date:
01/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DANDRAIA
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING COODINATOR
Authorized Official Telephone Number:
631-751-3000

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 03005369 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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