Healthcare Provider Details

I. General information

NPI: 1609919455
Provider Name (Legal Business Name): HEMATOLOGY-ONCOLOGY ASSOCIATES OF CNY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 10/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 BROAD RD
SYRACUSE NY
13215-2265
US

IV. Provider business mailing address

5008 BRITTONFIELD PKWY SUITE 700
EAST SYRACUSE NY
13057-9248
US

V. Phone/Fax

Practice location:
  • Phone: 315-472-7504
  • Fax: 315-479-8639
Mailing address:
  • Phone: 315-472-7504
  • Fax: 315-479-8639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL L NOTARO
Title or Position: CONTRACT ANALYST
Credential:
Phone: 315-472-7504