Healthcare Provider Details

I. General information

NPI: 1801097233
Provider Name (Legal Business Name): BROOME ONCOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 03/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 RIVERSIDE DR
BINGHAMTON NY
13905-4246
US

IV. Provider business mailing address

30 HARRISON ST SUITE 100
JOHNSON CITY NY
13790-2161
US

V. Phone/Fax

Practice location:
  • Phone: 607-798-5307
  • Fax: 607-798-5078
Mailing address:
  • Phone: 607-763-6850
  • Fax: 607-763-6703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: BUD ROGERS
Title or Position: BUSINESS MANAGER
Credential:
Phone: 607-763-8095