Provider Demographics
NPI:1528161692
Name:HEMATOLOGY ONCOLOGY ASSOCIATION OF LONG ISLAND
Entity type:Organization
Organization Name:HEMATOLOGY ONCOLOGY ASSOCIATION OF LONG ISLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NIRMALA
Authorized Official - Middle Name:K
Authorized Official - Last Name:SHEVDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-354-5700
Mailing Address - Street 1:3003 NEW HYDE PARK RD
Mailing Address - Street 2:STE 401
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1214
Mailing Address - Country:US
Mailing Address - Phone:516-354-5700
Mailing Address - Fax:516-354-6095
Practice Address - Street 1:3003 NEW HYDE PARK RD
Practice Address - Street 2:STE 401
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1214
Practice Address - Country:US
Practice Address - Phone:516-354-5700
Practice Address - Fax:516-354-6095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY127252174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW12971Medicare UPIN