Provider Demographics
NPI:1629275938
Name:HEMATOLOGY AND ONCOLOGY OF LI PLLC
Entity Type:Organization
Organization Name:HEMATOLOGY AND ONCOLOGY OF LI PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR AND OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NATAYLA
Authorized Official - Middle Name:
Authorized Official - Last Name:KRICHMAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-755-2404
Mailing Address - Street 1:PO BOX 1248
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-0490
Mailing Address - Country:US
Mailing Address - Phone:516-755-2404
Mailing Address - Fax:516-755-2405
Practice Address - Street 1:200 BOUNDARY AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-1152
Practice Address - Country:US
Practice Address - Phone:516-755-2404
Practice Address - Fax:516-755-2405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-29
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02777939Medicaid
NY02777939Medicaid
NYI52314Medicare UPIN