MEDICARE: NORTH SHORE HEMATOLOGY ONCOLOGY ASSOCIATES PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0003X	Hematology & Oncology Physician	222768	NY

General Provider Information

NPI Number	:	1164460754
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH SHORE HEMATOLOGY ONCOLOGY ASSOCIATES PC

Provider Business Mailing Address
First Line	:	1500 ROUTE 112 BLDG 4
Second Line	:
City	:	PORT JEFFERSON STATION
State	:	NY
Zip	:	11776-8055
Country	:	US
Telephone Number	:	631-751-3000
Fax Number	:	631-751-0506

Provider Business Practice Location Address
First Line	:	1 DELAWARE DR
Second Line	:
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11042-1116
Country	:	US
Telephone Number	:	516-336-5255
Fax Number	:	516-570-6527

Authorized Official
Title or Position	:	DIRECTOR OF CREDENTIALING
Name	:	PATRICIA DANDRAIA
Credential	:
Telephone Number	:	631-751-3000

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	12/06/2021

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