Healthcare Provider Details

I. General information

NPI: 1578761730
Provider Name (Legal Business Name): NORTH SHORE HEMATOLOGY ONCOLOGY ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 09/29/2022
Certification Date: 09/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 E MAIN ST
PATCHOGUE NY
11772-3145
US

IV. Provider business mailing address

1 RESEARCH RD
RIDGE NY
11961-2701
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierCC5178
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerRR MEDICARE

VIII. Authorized Official

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