Healthcare Provider Details

I. General information

NPI: 1629200035
Provider Name (Legal Business Name): MSKCC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2009
Last Update Date: 08/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 YORK AVE
NEW YORK NY
10065-6007
US

IV. Provider business mailing address

1275 YORK AVE
NEW YORK NY
10065-6007
US

V. Phone/Fax

Practice location:
  • Phone: 212-639-3210
  • Fax:
Mailing address:
  • Phone: 212-639-3210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code284300000X
TaxonomySpecial Hospital
License Number
License Number State

VIII. Authorized Official

Name: MRS. CHERAYLA DAVIS
Title or Position: MEDICINE RESIDENCY COORDINATOR
Credential:
Phone: 212-639-3210