Provider Demographics
NPI:1700960143
Name:HEMATOLOGY ONCOLOGY ASSOCIATES OF CENTRAL BREVARD
Entity Type:Organization
Organization Name:HEMATOLOGY ONCOLOGY ASSOCIATES OF CENTRAL BREVARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:KNIGHT
Authorized Official - Last Name:ERENTREICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-636-2111
Mailing Address - Street 1:107 LONGWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-2827
Mailing Address - Country:US
Mailing Address - Phone:321-636-2111
Mailing Address - Fax:321-636-9219
Practice Address - Street 1:107 LONGWOOD AVE
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-2827
Practice Address - Country:US
Practice Address - Phone:321-636-2111
Practice Address - Fax:321-636-9219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL24168Medicare ID - Type Unspecified