Healthcare Provider Details

I. General information

NPI: 1215018643
Provider Name (Legal Business Name): MADHUR K GARG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 01/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MMC - RADIATION ONCOLOGY 111 EAST 210TH STREET
BRONX NY
10467
US

IV. Provider business mailing address

31 SHELDON ST
ARDSLEY NY
10502-2504
US

V. Phone/Fax

Practice location:
  • Phone: 718-920-4140
  • Fax: 718-231-5064
Mailing address:
  • Phone: 718-920-4140
  • Fax: 718-231-5064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number241946
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: