Provider Demographics
NPI:1164455960
Name:SYNERGY HEMATOLOGY ONCOLOGY MEDICAL ASSOCIATES INC
Entity type:Organization
Organization Name:SYNERGY HEMATOLOGY ONCOLOGY MEDICAL ASSOCIATES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SPECTOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-525-1118
Mailing Address - Street 1:P.O. BOX 48107
Mailing Address - Street 2:SYNERGY HEMATOLOGY - ONCOLOGY MEDICAL ASSOCIATES, INC
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-0107
Mailing Address - Country:US
Mailing Address - Phone:323-525-1118
Mailing Address - Fax:818-303-1306
Practice Address - Street 1:8737 BEVERLY BLVD STE 203
Practice Address - Street 2:SYNERGY HEMATOLOGY - ONCOLOGY MEDICAL ASSOCIATES, INC.
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90048-1840
Practice Address - Country:US
Practice Address - Phone:323-525-1118
Practice Address - Fax:818-303-1306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA05D0724185174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0084550Medicaid
CA2093822OtherCORPORATE ID
CAGR0084551Medicaid
CA1068300002Medicare NSC
CA1068300001Medicare NSC
CAW14442Medicare PIN
CAGR0084551Medicaid
CAGR0084550Medicaid
CAW14442AMedicare PIN