Provider Demographics
NPI:1942363403
Name:GARDEN CITY ONCOLOGY,P.C.
Entity type:Organization
Organization Name:GARDEN CITY ONCOLOGY,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEO
Authorized Official - Middle Name:
Authorized Official - Last Name:WIENER
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:516-742-5353
Mailing Address - Street 1:520 FRANKLIN AVE
Mailing Address - Street 2:SUITE 253
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-5801
Mailing Address - Country:US
Mailing Address - Phone:516-742-5353
Mailing Address - Fax:516-742-4207
Practice Address - Street 1:520 FRANKLIN AVE
Practice Address - Street 2:SUITE 253
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-5801
Practice Address - Country:US
Practice Address - Phone:516-742-5353
Practice Address - Fax:516-742-4207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6287440001Medicare NSC
NYW32911Medicare ID - Type UnspecifiedMEDICARE GROUP ID #