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General NPI Number Information
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NPI Number | 1952715773
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Entity Type | Organization
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Legal Business Name | SOUTH NASSAU ONCOLOGY PRACTICE, PC
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Dates
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Enumeration Date | 06/19/2014
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Last Update Date | 06/19/2014
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Provider Practice Location Address
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Address Line | 242 MERRICK RD
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City | ROCKVILLE CENTRE
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State | NY
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Zip | 11570-5254
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Country | US
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Telephone | 516-536-1455
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Fax |
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Provider Business Mailing Address
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Address Line | 1 HEALTHY WAY PHYSICIAN BILLING
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City | OCEANSIDE
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State | NY
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Zip | 11572-1551
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Country | US
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Telephone | 516-255-1616
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Fax | 516-255-4672
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Authorized Official
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Title or Position | CFO
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Name | MR. MARK BOGEN
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Credential |
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Telephone | 516-632-3935
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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