Provider Demographics
NPI:1306021290
Name:QUEENS HEMATOLOGY ONCOLOGY PC
Entity Type:Organization
Organization Name:QUEENS HEMATOLOGY ONCOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ARAXI
Authorized Official - Middle Name:
Authorized Official - Last Name:GEVORGYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-830-6333
Mailing Address - Street 1:10850 62ND DR
Mailing Address - Street 2:SUITE LA
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-1261
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10850 62ND DR
Practice Address - Street 2:SUITE LA
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-1261
Practice Address - Country:US
Practice Address - Phone:718-830-6333
Practice Address - Fax:718-830-6355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY167703174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01844944Medicaid
NY01844944Medicaid