Healthcare Provider Details

I. General information

NPI: 1992750582
Provider Name (Legal Business Name): RICHARD M GEWANTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 04/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N VILLAGE AVE MEMORIAL SLOAN-KETTERING CANCER CENTER
ROCKVILLE CENTRE NY
11570-1000
US

IV. Provider business mailing address

1000 N VILLAGE AVE MEMORIAL SLOAN-KETTERING CANCER CENTER
ROCKVILLE CENTRE NY
11570-1000
US

V. Phone/Fax

Practice location:
  • Phone: 516-256-3600
  • Fax: 516-256-1644
Mailing address:
  • Phone: 516-256-3600
  • Fax: 516-256-1644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number209945-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: