Healthcare Provider Details

I. General information

NPI: 1538325782
Provider Name (Legal Business Name): RADIOSURGERY AMERICA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2008
Last Update Date: 03/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 MORRIS PARK AVE
BRONX NY
10461-1925
US

IV. Provider business mailing address

PO BOX 5918
HICKSVILLE NY
11802-5918
US

V. Phone/Fax

Practice location:
  • Phone: 212-246-4237
  • Fax:
Mailing address:
  • Phone: 512-583-0205
  • Fax: 512-583-2001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: GILBERT SEYMOUR LEDERMAN
Title or Position: OWNER
Credential: M.D.
Phone: 212-246-4237