Healthcare Provider Details

I. General information

NPI: 1568463339
Provider Name (Legal Business Name): SILVIA C. FORMENTI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 04/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 E 68TH ST
NEW YORK NY
10065-4870
US

IV. Provider business mailing address

525 E 68TH ST
NEW YORK NY
10065-4870
US

V. Phone/Fax

Practice location:
  • Phone: 212-746-3600
  • Fax: 212-746-6635
Mailing address:
  • Phone: 212-746-3600
  • Fax: 212-746-6635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number212254
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: