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General NPI Number Information
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NPI Number | 1497068043
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Entity Type | Organization
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Legal Business Name | THOMAS R. EANELLI RADIATION ONCOLOGY SERVICES, PLLC
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Dates
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Enumeration Date | 07/23/2010
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Last Update Date | 02/28/2011
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Provider Practice Location Address
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Address Line | 75 CRYSTAL RUN RD
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City | MIDDLETOWN
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State | NY
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Zip | 10941-7000
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Country | US
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Telephone | 845-695-5999
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Fax | 845-695-5832
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Provider Business Mailing Address
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Address Line | 1 INTERNATIONAL BLVD SUITE 1130
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City | MAHWAH
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State | NJ
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Zip | 07495-0027
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Country | US
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Telephone | 201-252-8468
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Fax | 201-252-8472
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Authorized Official
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Title or Position | OWNER
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Name | THOMAS R. EANELLI
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Credential | M.D.
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Telephone | 201-252-8468
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 172417
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License Number State | NY
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