Healthcare Provider Details

I. General information

NPI: 1033163506
Provider Name (Legal Business Name): BROOKLYN RADIATION ONCOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 10/09/2023
Certification Date: 10/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 AVENUE X
BROOKLYN NY
11235-2910
US

IV. Provider business mailing address

PO BOX 6054
SPRING HILL FL
34611-6054
US

V. Phone/Fax

Practice location:
  • Phone: 718-517-2900
  • Fax: 800-420-3318
Mailing address:
  • Phone: 917-688-2534
  • Fax: 800-420-3318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: LESLIE BOTNICK
Title or Position: MD,CEO
Credential: MD
Phone: 310-335-4067