Provider Demographics
NPI:1164538724
Name:HEMATOLOGY AND ONCOLOGY ASSOCIATES OF NORTHEASTERN PA, PC
Entity Type:Organization
Organization Name:HEMATOLOGY AND ONCOLOGY ASSOCIATES OF NORTHEASTERN PA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEANDRI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-342-3675
Mailing Address - Street 1:1100 MEADE ST
Mailing Address - Street 2:
Mailing Address - City:DUNMORE
Mailing Address - State:PA
Mailing Address - Zip Code:18512-3169
Mailing Address - Country:US
Mailing Address - Phone:570-342-3675
Mailing Address - Fax:570-342-3316
Practice Address - Street 1:1100 MEADE ST
Practice Address - Street 2:
Practice Address - City:DUNMORE
Practice Address - State:PA
Practice Address - Zip Code:18512-3169
Practice Address - Country:US
Practice Address - Phone:570-342-3675
Practice Address - Fax:570-342-3316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007315630006Medicaid
PA154139Medicare PIN
PA1007315630006Medicaid