Healthcare Provider Details

I. General information

NPI: 1073770533
Provider Name (Legal Business Name): SCRANTON HEMATOLOGY ONCOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 05/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

743 JEFFERSON AVE SUITE 205
SCRANTON PA
18510-1635
US

IV. Provider business mailing address

743 JEFFERSON AVE SUITE 205
SCRANTON PA
18510-1635
US

V. Phone/Fax

Practice location:
  • Phone: 570-558-3020
  • Fax: 570-558-3385
Mailing address:
  • Phone: 570-558-3020
  • Fax: 570-558-3385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD024781E
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier0010539300004
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: DR. MARTIN BERNARD HYZINSKI
Title or Position: PROPRIETOR
Credential: M.D.
Phone: 570-558-3020