Healthcare Provider Details

I. General information

NPI: 1922459163
Provider Name (Legal Business Name): MSK MONMOUTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2016
Last Update Date: 11/18/2020
Certification Date: 11/18/2020
Deactivation Date: 09/08/2020
Reactivation Date: 11/18/2020

III. Provider practice location address

480 RED HILL RD
MIDDLETOWN NJ
07748-3052
US

IV. Provider business mailing address

633 3RD AVE LBBY 3
NEW YORK NY
10017-6785
US

V. Phone/Fax

Practice location:
  • Phone: 908-542-3007
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: SALVATORE ANDREOZZI
Title or Position: VICE PRESIDENT
Credential:
Phone: 646-227-3751