Basic Information
Provider Information | |||||||||
NPI: | 1558625608 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | HUDSON VALLEY HEMATOLOGY ONCOLOGY ASSOCIATES RLLP | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 19 BAKER AVENUE | ||||||||
Address2: | SUITE 100 | ||||||||
City: | POUGHKEEPSIE | ||||||||
State: | NY | ||||||||
PostalCode: | 126011375 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8454541942 | ||||||||
FaxNumber: | 8454524638 | ||||||||
Practice Location | |||||||||
Address1: | 45 READE PL | ||||||||
Address2: | 1ST FLOOR | ||||||||
City: | POUGHKEEPSIE | ||||||||
State: | NY | ||||||||
PostalCode: | 126013947 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8454836800 | ||||||||
FaxNumber: | 8454836801 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/03/2012 | ||||||||
LastUpdateDate: | 07/03/2012 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | KANCHERLA | ||||||||
AuthorizedOfficialFirstName: | RAMAMOHANA | ||||||||
AuthorizedOfficialMiddleName: | R | ||||||||
AuthorizedOfficialTitleorPosition: | MANAGING PARTNER | ||||||||
AuthorizedOfficialTelephone: | 84545491942 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | MD | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X |   | NY | Y |   | Suppliers | Durable Medical Equipment & Medical Supplies |   |
ID Information
ID | Type | State | Issuer | Description | W15091 | 01 | NY | PTAN | OTHER |