14D0864311 CLIA NUMBER - NSHOA DBA NEW YORK CANCER AND BLOOD SPECIALIST

Laboratory Demographics

CLIA Number: 14D0864311

Facility Name: NSHOA DBA NEW YORK CANCER AND BLOOD SPECIALIST

Facility Address:
611 GIDNEY AVENUE
NEWBURGH, NY
ZIP 12550
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Facility Phone Number: 631 663-4871

Facility Type: Physician Office

Certificate Type: Certificate of Compliance

NPI Number: 1033260419

Taxonomy: 207RH0003X - Internal Medicine
An internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine WAS able to obtain a Certificate of Special Qualifications in the field of Hematology and Oncology. The Certificate is NO longer offered.

CLIA Record

Field Name	Field Value
CLIA Number	14D0864311
LAB Type	Physician Office
Facility Name	NSHOA DBA NEW YORK CANCER AND BLOOD SPECIALIST
Street	611 GIDNEY AVENUE
City	NEWBURGH
State	NY
ZIP	12550
Phone	631 663-4871
CertificateType	2
CertificateEffectiveDate	10/1/2021
CertificateExpirationDate	4/30/2024
FacilityType	Compliance

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This page was last updated on: 4/23/2024