Provider Demographics
NPI:1669576211
Name:HEMATOLOGY ONCOLOGY CONSULTANTS
Entity type:Organization
Organization Name:HEMATOLOGY ONCOLOGY CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:LEONARD
Authorized Official - Last Name:GOLDSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-994-0101
Mailing Address - Street 1:6850 SEPULVEDA BLVD 211
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-4451
Mailing Address - Country:US
Mailing Address - Phone:818-994-0101
Mailing Address - Fax:818-902-5566
Practice Address - Street 1:23101 SHERMAN PL
Practice Address - Street 2:410
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-2003
Practice Address - Country:US
Practice Address - Phone:818-587-9380
Practice Address - Fax:818-346-7025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2014-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0044501Medicaid
CAZZZ47615ZOtherBLUE SHIELD
1669576211Medicare PIN
1851495501Medicare PIN
CAZZZ47615ZOtherBLUE SHIELD
1487758033Medicare PIN