Healthcare Provider Details

I. General information

NPI: 1982759577
Provider Name (Legal Business Name): STEPHEN WAYNE GILHEENEY MD, MMS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MEMORIAL SLOAN KETTERING CANCER CENTER 1275 YORK AVENUE
NEW YORK NY
10021
US

IV. Provider business mailing address

345 E 94TH ST APARTMENT 15B
NEW YORK NY
10128-5684
US

V. Phone/Fax

Practice location:
  • Phone: 212-639-2153
  • Fax: 212-717-3239
Mailing address:
  • Phone: 212-534-6848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number218757
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: