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General NPI Number Information
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NPI Number | 1710970074
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Entity Type | Organization
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Legal Business Name | NORTHEAST MEDICAL ONCOLOGY ASSOCIATES, INC.
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Dates
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Enumeration Date | 08/23/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1740 E BROAD ST
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City | HAZLETON
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State | PA
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Zip | 18201-5667
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Country | US
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Telephone | 570-459-2902
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Fax | 570-459-6090
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Provider Business Mailing Address
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Address Line | 1740 E BROAD ST
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City | HAZLETON
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State | PA
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Zip | 18201-5667
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Country | US
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Telephone | 570-459-2902
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Fax | 570-459-6090
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Authorized Official
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Title or Position | DIRECTOR ACTIVE,ATTENDING
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Name | HARSH GANDHI
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Credential | MD
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Telephone | 570-459-2902
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RX0202X
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Taxonomy Name | Medical Oncology Physician
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License Number | MD037484E
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License Number State | PA
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