Healthcare Provider Details

I. General information

NPI: 1821054701
Provider Name (Legal Business Name): FLORIDA HEMATOLOGY & ONCOLOGY SPECIALISTS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 04/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 N ORANGE AVE SUITE 201
ORLANDO FL
32804-4603
US

IV. Provider business mailing address

PO BOX 741240
ORANGE CITY FL
32774-1240
US

V. Phone/Fax

Practice location:
  • Phone: 386-774-5211
  • Fax: 386-774-5251
Mailing address:
  • Phone: 386-774-5211
  • Fax: 386-774-5251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberBUS0000580-04
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License NumberBUS0000580-004
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberBUS0000580-004
License Number StateFL

VIII. Authorized Official

Name: ROY M AMBINDER
Title or Position: PRESIDENT
Credential: M. D.
Phone: 386-774-5211