Provider Demographics
NPI:1942256524
Name:WEST SIDE HEMATOLOGY & ONCOLOGY, PC.
Entity Type:Organization
Organization Name:WEST SIDE HEMATOLOGY & ONCOLOGY, PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:SARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-977-9292
Mailing Address - Street 1:30 W 60TH ST
Mailing Address - Street 2:CARE OF GABRIEL SARA MD
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-7902
Mailing Address - Country:US
Mailing Address - Phone:212-977-9292
Mailing Address - Fax:212-523-8560
Practice Address - Street 1:30 W 60TH ST
Practice Address - Street 2:CARE OF GABRIEL SARA MD
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-7902
Practice Address - Country:US
Practice Address - Phone:212-977-9292
Practice Address - Fax:212-523-8560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW325410Medicare PIN