Healthcare Provider Details

I. General information

NPI: 1679092381
Provider Name (Legal Business Name): MEMORIAL SLOAN KETTERING CANCER CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2017
Last Update Date: 09/19/2025
Certification Date: 03/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 MOUNTAINVIEW BLVD STE 171
BASKING RIDGE NJ
07920-3444
US

IV. Provider business mailing address

1275 YORK AVE RM H-313
NEW YORK NY
10065-6007
US

V. Phone/Fax

Practice location:
  • Phone: 908-542-3443
  • Fax: 201-691-6432
Mailing address:
  • Phone: 212-639-2206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number28RS00757700
License Number StateNJ

VIII. Authorized Official

Name: SUSAN MURILLO
Title or Position: PHARMACY MANAGER
Credential:
Phone: 212-639-2206