Healthcare Provider Details

I. General information

NPI: 1265560015
Provider Name (Legal Business Name): HEMATOLOGY AND ONCOLOGY ASSOCIATES OF NORTHEASTERN PA, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 07/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 MORGAN HWY SUITE 8
SCRANTON PA
18508-2641
US

IV. Provider business mailing address

5 MORGAN HWY SUITE 8
SCRANTON PA
18508-2641
US

V. Phone/Fax

Practice location:
  • Phone: 570-342-3675
  • Fax: 570-342-3316
Mailing address:
  • Phone: 570-342-3675
  • Fax: 570-342-3316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

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

# 1
Identifier1007315630006
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: WILLIAM J HEIM
Title or Position: PRESIDENT
Credential: MD
Phone: 570-342-3675