Basic Information
| Provider Information | |||||||||
| NPI: | 1659321859 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FINGER LAKES HEMATOLOGY & ONCOLOGY PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6 AMBULANCE DRIVE | ||||||||
| Address2: | |||||||||
| City: | CLIFTON SPRINGS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154621472 | ||||||||
| FaxNumber: | 3154622639 | ||||||||
| Practice Location | |||||||||
| Address1: | 6 AMBULANCE DRIVE | ||||||||
| Address2: | |||||||||
| City: | CLIFTON SPRINGS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154621472 | ||||||||
| FaxNumber: | 3154622639 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2006 | ||||||||
| LastUpdateDate: | 07/13/2007 | ||||||||
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| AuthorizedOfficialLastName: | IGNACZAK | ||||||||
| AuthorizedOfficialFirstName: | STEPHEN | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 3154621472 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 02332763 | 05 | NY | MEDICAID |