Healthcare Provider Details

I. General information

NPI: 1013102185
Provider Name (Legal Business Name): BAY RADIATION ONCOLOGY,P.L.L.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 09/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 BOULEVARD
PASSAIC NJ
07055-2840
US

IV. Provider business mailing address

150W 79TH ST. APT 2A
NEW YORK NY
10024
US

V. Phone/Fax

Practice location:
  • Phone: 973-365-5088
  • Fax:
Mailing address:
  • Phone: 212-799-0196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0203X
TaxonomyTherapeutic Radiology Physician
License Number25MA04364400
License Number StateNJ

VIII. Authorized Official

Name: DR. SUNG I LEE
Title or Position: MEMBER
Credential: M.D.
Phone: 212-799-0196