Healthcare Provider Details

I. General information

NPI: 1841203056
Provider Name (Legal Business Name): MAIMONIDES DIVISION OF RADIATION ONCOLOGY, FPP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 03/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6300 8TH AVE
BROOKLYN NY
11220-4718
US

IV. Provider business mailing address

6300 8TH AVE
BROOKLYN NY
11220-4718
US

V. Phone/Fax

Practice location:
  • Phone: 718-765-2722
  • Fax: 718-765-2727
Mailing address:
  • Phone: 718-765-2722
  • Fax: 718-765-2727

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: DR. JAY COOPER
Title or Position: OWNER
Credential: MD
Phone: 718-765-2722