Provider Demographics
NPI:1861560906
Name:EASTERN LONG ISLAND HEMATOLOGY ONCOLOGY, P.C.
Entity type:Organization
Organization Name:EASTERN LONG ISLAND HEMATOLOGY ONCOLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LYNN KAY
Authorized Official - Middle Name:
Authorized Official - Last Name:WINTERS
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:631-727-8827
Mailing Address - Street 1:1333 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-1524
Mailing Address - Country:US
Mailing Address - Phone:631-727-8827
Mailing Address - Fax:
Practice Address - Street 1:1333 E MAIN ST
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-1524
Practice Address - Country:US
Practice Address - Phone:631-727-8827
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWXRWT1Medicare PIN
NY6604730001Medicare NSC