Healthcare Provider Details

I. General information

NPI: 1306923875
Provider Name (Legal Business Name): LEADING EDGE RADIATION ONCOLOGY SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 06/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8715 5TH AVENUE
BROOKLYN NY
11209
US

IV. Provider business mailing address

8715 5TH AVENUE
BROOKLYN NY
11209
US

V. Phone/Fax

Practice location:
  • Phone: 718-836-2200
  • Fax: 718-836-2226
Mailing address:
  • Phone: 718-836-2200
  • Fax: 718-836-2226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SAMEER RAFLA
Title or Position: PRESIDENT
Credential: MD
Phone: 718-836-2200