Healthcare Provider Details

I. General information

NPI: 1427039320
Provider Name (Legal Business Name): RADIATION ONCOLOGY MEDICAL PRACTICE OF ST VINCENTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 09/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

PO BOX 26179
NEW YORK NY
10087-6179
US

V. Phone/Fax

Practice location:
  • Phone: 212-604-6081
  • Fax: 212-367-1742
Mailing address:
  • Phone: 770-693-6022
  • Fax: 770-693-6039

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: ANTHONY M BERSON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 212-576-9800