Healthcare Provider Details

I. General information

NPI: 1528784634
Provider Name (Legal Business Name): NORTH SHORE HEMATOLOGY ONCOLOGY ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2022
Last Update Date: 06/02/2023
Certification Date: 06/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2236 NOSTRAND AVE
BROOKLYN NY
11210-3037
US

IV. Provider business mailing address

1 RESEARCH RD
RIDGE NY
11961-2701
US

V. Phone/Fax

Practice location:
  • Phone: 347-418-4437
  • Fax: 631-751-0506
Mailing address:
  • Phone: 631-751-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QX0200X
TaxonomyOncology Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QX0203X
TaxonomyRadiation Oncology Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA DANDRAIA
Title or Position: DIRECTOR
Credential:
Phone: 631-751-3000