Provider Demographics
NPI:1659321859
Name:FINGER LAKES HEMATOLOGY & ONCOLOGY PLLC
Entity Type:Organization
Organization Name:FINGER LAKES HEMATOLOGY & ONCOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:IGNACZAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-462-1472
Mailing Address - Street 1:6 AMBULANCE DRIVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:14432
Mailing Address - Country:US
Mailing Address - Phone:315-462-1472
Mailing Address - Fax:315-462-2639
Practice Address - Street 1:6 AMBULANCE DRIVE
Practice Address - Street 2:
Practice Address - City:CLIFTON SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:14432
Practice Address - Country:US
Practice Address - Phone:315-462-1472
Practice Address - Fax:315-462-2639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02332763Medicaid
NY02332763Medicaid