Healthcare Provider Details

I. General information

NPI: 1104827419
Provider Name (Legal Business Name): JOHN RESCIGNO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 08/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 E 77TH ST
NEW YORK NY
10075-1817
US

IV. Provider business mailing address

325W 15TH ST
NEW YORK NY
10011-5903
US

V. Phone/Fax

Practice location:
  • Phone: 212-722-2130
  • Fax: 212-722-2147
Mailing address:
  • Phone: 212-604-6081
  • Fax: 212-367-1742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number187259-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: