Healthcare Provider Details

I. General information

NPI: 1306196605
Provider Name (Legal Business Name): RICHARD BAMBURY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2012
Last Update Date: 08/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

353 E 68TH ST SIDNEY KIMMEL CENTER FOR PROSTATE AND UROLOGIC CANCERS
NEW YORK NY
10065-5606
US

IV. Provider business mailing address

1275 YORK AVE
NEW YORK NY
10065-6007
US

V. Phone/Fax

Practice location:
  • Phone: 212-639-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number275123
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: