Basic Information
| Provider Information | |||||||||
| NPI: | 1457831018 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NORTH SHORE HEMATOLOGY ONCOLOGY ASSOCIATES PC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | NY CANCER & BLOOD SPECIALISTS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 RESEARCH RD | ||||||||
| Address2: | |||||||||
| City: | RIDGE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 119612701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6317513000 | ||||||||
| FaxNumber: | 6317510506 | ||||||||
| Practice Location | |||||||||
| Address1: | 8806 55TH AVE | ||||||||
| Address2: | |||||||||
| City: | ELMHURST | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113734437 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186519398 | ||||||||
| FaxNumber: | 6317510506 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2018 | ||||||||
| LastUpdateDate: | 05/18/2022 | ||||||||
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| AuthorizedOfficialLastName: | DANDRAIA | ||||||||
| AuthorizedOfficialFirstName: | PATRICIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF CREDENTIALING | ||||||||
| AuthorizedOfficialTelephone: | 6317513000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | NORTH SHORE HEMATOLOGY ONCOLOGY ASSOCIATES PC | ||||||||
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| NPICertificationDate: | 05/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 207RN0300X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 208800000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology | 333600000X | N | Suppliers | Pharmacy | 261QR0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Radiology |
No ID Information.