Provider Demographics
NPI:1346448784
Name:FOREST HILLS HEMATOLOGY & ONCOLOGY PC
Entity Type:Organization
Organization Name:FOREST HILLS HEMATOLOGY & ONCOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER RELATIONS SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:VLADIMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:GOTLIEB
Authorized Official - Suffix:
Authorized Official - Credentials:KARINA NATANZON
Authorized Official - Phone:718-333-1394
Mailing Address - Street 1:80 SLOCUM CRES
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-5237
Mailing Address - Country:US
Mailing Address - Phone:718-459-5900
Mailing Address - Fax:718-459-5902
Practice Address - Street 1:10025 QUEENS BLVD STE 1N
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-2450
Practice Address - Country:US
Practice Address - Phone:718-459-5900
Practice Address - Fax:718-459-5902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-06
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY218369174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02669267Medicaid
NY7299223OtherGHI
NY02669267Medicaid
NY07304AMedicare ID - Type UnspecifiedGHI MEDICARE
5Z9111Medicare ID - Type UnspecifiedEMPIRE MEDICARE