Provider Demographics
NPI:1740371103
Name:SOUTH SHORE HEMATOLOGY-ONCOLOGY ASSOCIATES, P.C.
Entity type:Organization
Organization Name:SOUTH SHORE HEMATOLOGY-ONCOLOGY ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:J
Authorized Official - Last Name:SULSENTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-536-1455
Mailing Address - Street 1:242 MERRICK RD
Mailing Address - Street 2:STE 301
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-5254
Mailing Address - Country:US
Mailing Address - Phone:516-536-1455
Mailing Address - Fax:516-536-1598
Practice Address - Street 1:242 MERRICK RD
Practice Address - Street 2:STE 301
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-5254
Practice Address - Country:US
Practice Address - Phone:516-536-1455
Practice Address - Fax:516-536-1598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01762550Medicaid
NY01762550Medicaid