Basic Information
| Provider Information | |||||||||
| NPI: | 1700960143 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEMATOLOGY ONCOLOGY ASSOCIATES OF CENTRAL BREVARD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 107 LONGWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | ROCKLEDGE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329552827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3216362111 | ||||||||
| FaxNumber: | 3216369219 | ||||||||
| Practice Location | |||||||||
| Address1: | 107 LONGWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | ROCKLEDGE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329552827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3216362111 | ||||||||
| FaxNumber: | 3216369219 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2006 | ||||||||
| LastUpdateDate: | 11/26/2007 | ||||||||
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| AuthorizedOfficialLastName: | ERENTREICH | ||||||||
| AuthorizedOfficialFirstName: | GAIL | ||||||||
| AuthorizedOfficialMiddleName: | KNIGHT | ||||||||
| AuthorizedOfficialTitleorPosition: | PRACTICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3216362111 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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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 |
No ID Information.