Healthcare Provider Details

I. General information

NPI: 1982376216
Provider Name (Legal Business Name): NORTH SHORE HEMATOLOGY/ONCOLOGY ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2021
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1158 BROADWAY
HEWLETT NY
11557-2302
US

IV. Provider business mailing address

1500 ROUTE 112 BLDG 4
PORT JEFFERSON STATION NY
11776-8055
US

V. Phone/Fax

Practice location:
  • Phone: 631-751-3000
  • Fax: 631-751-0506
Mailing address:
  • Phone: 163-175-1300
  • Fax: 631-751-0506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

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