Healthcare Provider Details

I. General information

NPI: 1659385474
Provider Name (Legal Business Name): MEMORIAL HOSPITAL FOR CANCER & ALLIED DISEASES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 04/25/2023
Certification Date: 04/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 MOUNTAIN VIEW BLVD
BASKING RIDGE NJ
07920-3444
US

IV. Provider business mailing address

1275 YORK AVE
NEW YORK NY
10021-6007
US

V. Phone/Fax

Practice location:
  • Phone: 908-542-3000
  • Fax:
Mailing address:
  • Phone: 212-639-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number7002020H
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number7002020H
License Number StateNY

VIII. Authorized Official

Name: KATHRYN MARTIN
Title or Position: COO
Credential:
Phone: 212-639-2623