Provider Demographics
NPI:1902905425
Name:HEMATOLOGY ASC MT SINAI
Entity type:Organization
Organization Name:HEMATOLOGY ASC MT SINAI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-442-4260
Mailing Address - Street 1:PO BOX 24908
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-0908
Mailing Address - Country:US
Mailing Address - Phone:440-442-4260
Mailing Address - Fax:702-255-7699
Practice Address - Street 1:730 SOM CENTER RD
Practice Address - Street 2:SUITE 305
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44143-2350
Practice Address - Country:US
Practice Address - Phone:440-442-4260
Practice Address - Fax:702-255-7699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35026657L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0391839Medicaid
OHCD3403OtherRAILROAD MEDICARE
OH0391839Medicaid