Basic Information
Provider Information | |||||||||
NPI: | 1750424610 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | HEMATOLOGY-ONCOLOGY ASSOCIATES OF CNY | ||||||||
LastName: |   | ||||||||
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Mailing Information | |||||||||
Address1: | 5008 BRITTONFIELD PKWY | ||||||||
Address2: | SUITE 700 | ||||||||
City: | EAST SYRACUSE | ||||||||
State: | NY | ||||||||
PostalCode: | 130579248 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3154727504 | ||||||||
FaxNumber: | 3154798639 | ||||||||
Practice Location | |||||||||
Address1: | 107 E CHESTNUT ST | ||||||||
Address2: | SUITE 106 | ||||||||
City: | ROME | ||||||||
State: | NY | ||||||||
PostalCode: | 134402834 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3153395783 | ||||||||
FaxNumber: | 3156345179 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/14/2007 | ||||||||
LastUpdateDate: | 10/20/2009 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
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AuthorizedOfficialLastName: | NOTARO | ||||||||
AuthorizedOfficialFirstName: | MICHAEL | ||||||||
AuthorizedOfficialMiddleName: | L | ||||||||
AuthorizedOfficialTitleorPosition: | CONTRACT ANALYST | ||||||||
AuthorizedOfficialTelephone: | 3154727504 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical | 2085R0001X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 363A00000X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |   | 363L00000X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |   | 207RH0003X |   |   | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
No ID Information.