Provider Demographics
NPI:1720266356
Name:ISLAND ONCOLOGY HEMATOLOGY ASSOCIATES,P.C.
Entity Type:Organization
Organization Name:ISLAND ONCOLOGY HEMATOLOGY ASSOCIATES,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:STAUDTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-796-1500
Mailing Address - Street 1:3601 HEMPSTEAD TPKE
Mailing Address - Street 2:SUITE 421
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756-1375
Mailing Address - Country:US
Mailing Address - Phone:516-796-1500
Mailing Address - Fax:
Practice Address - Street 1:3601 HEMPSTEAD TPKE
Practice Address - Street 2:SUITE 421
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756-1375
Practice Address - Country:US
Practice Address - Phone:516-796-1500
Practice Address - Fax:516-579-1905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY095557174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCI0367OtherRAILROAD MEDICARE
NYCI0367OtherRAILROAD MEDICARE
NY913622Medicare PIN