Healthcare Provider Details

I. General information

NPI: 1700064003
Provider Name (Legal Business Name): GRAMERCY RADIATION ONCOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2008
Last Update Date: 02/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 POLY PL
BROOKLYN NY
11209-7104
US

IV. Provider business mailing address

PO BOX 90767
BROOKLYN NY
11209-0767
US

V. Phone/Fax

Practice location:
  • Phone: 718-630-3605
  • Fax: 718-630-2857
Mailing address:
  • Phone: 718-630-3605
  • Fax: 718-630-2857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNY

VIII. Authorized Official

Name: DR. DAVID L SCHWARTZ
Title or Position: PRINCIPAL OFFICER
Credential: M.D.
Phone: 718-630-3605