Healthcare Provider Details

I. General information

NPI: 1245323872
Provider Name (Legal Business Name): RADIOTHERAPY ASSOC. OF UPSTATE NY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 JAMES STREET
SYRACUSE NY
13203
US

IV. Provider business mailing address

815 JAMES STREET
SYRACUSE NY
13203
US

V. Phone/Fax

Practice location:
  • Phone: 315-474-4475
  • Fax: 315-475-6928
Mailing address:
  • Phone: 315-474-4475
  • Fax: 315-475-6928

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: NABILA A. ELBADAWI
Title or Position: CO-DIRECTOR
Credential: M.D.
Phone: 315-474-4475