Provider Demographics
NPI:1073629689
Name:MID HUDSON HEMATOLOGY ONCOLOGY PC
Entity Type:Organization
Organization Name:MID HUDSON HEMATOLOGY ONCOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:MARC
Authorized Official - Last Name:DIAMOND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-534-3888
Mailing Address - Street 1:164 WILLOW AVE
Mailing Address - Street 2:
Mailing Address - City:CORNWALL
Mailing Address - State:NY
Mailing Address - Zip Code:12518-1329
Mailing Address - Country:US
Mailing Address - Phone:845-534-3888
Mailing Address - Fax:845-534-4208
Practice Address - Street 1:164 WILLOW AVE
Practice Address - Street 2:
Practice Address - City:CORNWALL
Practice Address - State:NY
Practice Address - Zip Code:12518-1329
Practice Address - Country:US
Practice Address - Phone:845-534-3888
Practice Address - Fax:845-534-4208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW35962Medicare ID - Type UnspecifiedGROUP PRACTICE CORNWALL