Provider Demographics
NPI:1316375975
Name:INTERNAL MEDICINE HEMATOLOGY AND CANCER CARE PC
Entity Type:Organization
Organization Name:INTERNAL MEDICINE HEMATOLOGY AND CANCER CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:IFTIKHAR-AHMAD
Authorized Official - Middle Name:SHAHID
Authorized Official - Last Name:CHOUHDRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-292-6151
Mailing Address - Street 1:191 RADCLIFF RD
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:NY
Mailing Address - Zip Code:12734-5306
Mailing Address - Country:US
Mailing Address - Phone:845-292-6804
Mailing Address - Fax:
Practice Address - Street 1:184 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:NY
Practice Address - Zip Code:12754-1820
Practice Address - Country:US
Practice Address - Phone:845-292-6151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-17
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1656122-1207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB19215Medicare UPIN