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General NPI Number Information
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NPI Number | 1790036234
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Entity Type | Organization
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Legal Business Name | BROOKLYN CANCER CARE MEDICAL PC
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Dates
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Enumeration Date | 09/24/2012
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Last Update Date | 09/19/2023
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Provider Practice Location Address
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Address Line | 672 UTICA AVE
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City | BROOKLYN
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State | NY
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Zip | 11203-2210
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Country | US
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Telephone | 718-221-9999
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Fax | 516-693-9285
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Provider Business Mailing Address
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Address Line | 123 BACON RD
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City | OLD WESTBURY
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State | NY
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Zip | 11568-1304
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Country | US
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Telephone | 718-221-9999
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Fax | 516-693-9285
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Authorized Official
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Title or Position | MD
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Name | RATESH KHILLAN
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Credential | MD
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Telephone | 718-221-9999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 266181
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License Number State | NY
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