Healthcare Provider Details

I. General information

NPI: 1518936566
Provider Name (Legal Business Name): INTERLAKES ONCOLOGY & HEMATOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 04/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 WHITE SPRUCE BLVD
ROCHESTER NY
14623-1616
US

IV. Provider business mailing address

211 WHITE SPRUCE BLVD
ROCHESTER NY
14623-1616
US

V. Phone/Fax

Practice location:
  • Phone: 585-475-8700
  • Fax: 585-475-9411
Mailing address:
  • Phone: 585-475-8700
  • Fax: 585-475-9411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number StateNY

VIII. Authorized Official

Name: MS. SUSAN BARBATO
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 585-475-8727