Healthcare Provider Details

I. General information

NPI: 1598766164
Provider Name (Legal Business Name): WHITE PLAINS RADIATION THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 09/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 LONGVIEW AVE LOWER LEVEL
WHITE PLAINS NY
10601-5002
US

IV. Provider business mailing address

2 LONGVIEW AVE LOWER LEVEL
WHITE PLAINS NY
10601-5002
US

V. Phone/Fax

Practice location:
  • Phone: 914-681-2727
  • Fax: 914-681-2795
Mailing address:
  • Phone: 914-681-2727
  • Fax: 914-681-2795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0203X
TaxonomyTherapeutic Radiology Physician
License Number176121
License Number StateNY

VIII. Authorized Official

Name: PAUL T KHOURY
Title or Position: DIRECTOR
Credential: MD
Phone: 914-681-1219