Healthcare Provider Details

I. General information

NPI: 1649279241
Provider Name (Legal Business Name): INTENSITY MODULATED RADIATION THERAPY ASSOCIATES P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 06/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 E BROWN ST
EAST STROUDSBURG PA
18301-3005
US

IV. Provider business mailing address

PO BOX 62254
BALTIMORE MD
21264-2254
US

V. Phone/Fax

Practice location:
  • Phone: 570-476-3488
  • Fax: 570-476-3473
Mailing address:
  • Phone: 570-451-3910
  • Fax: 570-451-3236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL J. GREENBERG
Title or Position: RADIATION ONCOLOGIST
Credential: M.D.
Phone: 570-476-3488