MEDICARE: INTERLAKES ONCOLOGY & HEMATOLOGY 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		NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518936566
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERLAKES ONCOLOGY & HEMATOLOGY PC

Provider Business Mailing Address
First Line	:	211 WHITE SPRUCE BLVD
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14623-1616
Country	:	US
Telephone Number	:	585-475-8700
Fax Number	:	585-475-9411

Provider Business Practice Location Address
First Line	:	211 WHITE SPRUCE BLVD
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14623-1616
Country	:	US
Telephone Number	:	585-475-8700
Fax Number	:	585-475-9411

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. SUSAN BARBATO
Credential	:
Telephone Number	:	585-475-8727

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	04/16/2014

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