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General NPI Number Information
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NPI Number | 1902109713
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Entity Type | Organization
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Legal Business Name | SOUTH NASSAU ONCOLOGY, PC
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Dates
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Enumeration Date | 12/16/2010
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Last Update Date | 12/16/2010
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Provider Practice Location Address
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Address Line | 1 HEALTHY WAY
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City | OCEANSIDE
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State | NY
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Zip | 11572-1551
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Country | US
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Telephone | 516-632-3303
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Fax | 516-632-3325
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Provider Business Mailing Address
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Address Line | 1115 MAIN ST
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City | PLEASANT VIEW
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State | TN
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Zip | 37146-8136
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Country | US
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Telephone | 866-353-0360
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Fax | 615-523-2882
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EDWARD MULLEN
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Credential | MD
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Telephone | 516-632-3303
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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 |
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License Number State | NY
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