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General NPI Number Information
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NPI Number | 1467943522
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Entity Type | Organization
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Legal Business Name | NORTH SHORE HEMATOLOGY ONCOLOGY ASSOCIATES PC
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Dates
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Enumeration Date | 05/24/2018
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Last Update Date | 01/31/2020
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Provider Practice Location Address
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Address Line | 750 OLD COUNTRY RD BLDG 2
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City | RIVERHEAD
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State | NY
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Zip | 11901
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Country | US
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Telephone | 631-751-3000
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Fax | 631-509-6559
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Provider Business Mailing Address
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Address Line | 1500 ROUTE 112 STE 101
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City | PORT JEFFERSON STATION
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State | NY
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Zip | 11776-8054
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Country | US
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Telephone | 631-751-3000
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Fax | 631-509-6559
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | PATRICIA DANDRAIA
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Credential | CREDENTIALING
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Telephone | 631-751-3000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QX0203X
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Taxonomy Name | Radiation Oncology Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number |
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License Number State |
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