Provider Demographics
NPI:1821047325
Name:SOUTHERN TIER ONCOLOGY, PC
Entity Type:Organization
Organization Name:SOUTHERN TIER ONCOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:ABDERHALDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:607-737-8165
Mailing Address - Street 1:PO BOX 366
Mailing Address - Street 2:202 TAUGHANNOCK BLVD
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14851
Mailing Address - Country:US
Mailing Address - Phone:607-266-3257
Mailing Address - Fax:607-277-4056
Practice Address - Street 1:600 ROE AVENUE
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14905
Practice Address - Country:US
Practice Address - Phone:607-737-8165
Practice Address - Fax:607-737-8175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY53787AMedicare ID - Type Unspecified