Provider Demographics
NPI:1467594598
Name:PEDIATRIC HEMATOLOGY ONCOLOGY ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:PEDIATRIC HEMATOLOGY ONCOLOGY ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:D
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-253-5993
Mailing Address - Street 1:333 E VIRGINIA AVE
Mailing Address - Street 2:#210
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-1206
Mailing Address - Country:US
Mailing Address - Phone:602-253-5993
Mailing Address - Fax:602-253-4254
Practice Address - Street 1:333 E VIRGINIA AVE
Practice Address - Street 2:#210
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1206
Practice Address - Country:US
Practice Address - Phone:602-253-5993
Practice Address - Fax:602-253-4254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9868174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ201062Medicaid
AZ201062Medicaid