Provider Demographics
NPI:1710160254
Name:HEMATOLOGY ONCOLOGY ASSOCIATES OF THE PALM BEACHES
Entity Type:Organization
Organization Name:HEMATOLOGY ONCOLOGY ASSOCIATES OF THE PALM BEACHES
Other - Org Name:HEMATOLOGY ONCOLOGY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SURENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIRPAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-965-1864
Mailing Address - Street 1:3450 LANTANA RD
Mailing Address - Street 2:SUTIE 100
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33462-1329
Mailing Address - Country:US
Mailing Address - Phone:561-965-1864
Mailing Address - Fax:561-434-9157
Practice Address - Street 1:12993 SOUTHERN BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-9215
Practice Address - Country:US
Practice Address - Phone:561-793-0106
Practice Address - Fax:561-793-0860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL057839800Medicaid
FL97212Medicare PIN