Basic Information
| Provider Information | |||||||||
| NPI: | 1285899583 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LONG ISLAND MEDICAL ONCOLOGY & HEMATOLOGY ASSOC. P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2209 MERRICK RD | ||||||||
| Address2: | 101 | ||||||||
| City: | MERRICK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115664786 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5165465000 | ||||||||
| FaxNumber: | 5165460596 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 S CENTRAL AVE | ||||||||
| Address2: | |||||||||
| City: | VALLEY STREAM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115805443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5166323301 | ||||||||
| FaxNumber: | 5166323305 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2008 | ||||||||
| LastUpdateDate: | 07/25/2008 | ||||||||
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| AuthorizedOfficialLastName: | WEINER | ||||||||
| AuthorizedOfficialFirstName: | DORON | ||||||||
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| AuthorizedOfficialTitleorPosition: | M.D. | ||||||||
| AuthorizedOfficialTelephone: | 5165464000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 180907-1 | NY | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.