Healthcare Provider Details

I. General information

NPI: 1114242989
Provider Name (Legal Business Name): NYC STEREOTACTIC RADIOSURGERY , PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2010
Last Update Date: 04/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 WEST 55 STREET NYC STEREOTACTIC RADIOSURGERY,PLLC GROUND FLOOR
NEW YORK NY
10019-4403
US

IV. Provider business mailing address

1855 RICHMOND AVE SUITE 101
STATEN ISLAND NY
10314-3912
US

V. Phone/Fax

Practice location:
  • Phone: 718-761-4444
  • Fax: 718-761-4453
Mailing address:
  • Phone: 718-761-4444
  • Fax: 718-761-4444

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. DAVID LAWENCE SCHWARTZ
Title or Position: MEDICAL DIRECTOR
Credential: M.D.,
Phone: 718-351-9750