Healthcare Provider Details

I. General information

NPI: 1285899583
Provider Name (Legal Business Name): LONG ISLAND MEDICAL ONCOLOGY & HEMATOLOGY ASSOC. P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2008
Last Update Date: 07/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 S CENTRAL AVE
VALLEY STREAM NY
11580-5443
US

IV. Provider business mailing address

2209 MERRICK RD 101
MERRICK NY
11566-4786
US

V. Phone/Fax

Practice location:
  • Phone: 516-632-3301
  • Fax: 516-632-3305
Mailing address:
  • Phone: 516-546-5000
  • Fax: 516-546-0596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number180907-1
License Number StateNY

VIII. Authorized Official

Name: DR. DORON WEINER
Title or Position: M.D.
Credential: M.D.
Phone: 516-546-4000