=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962677203
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEMORIAL SLOAN KETTERING CANCER CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/28/2008
-----------------------------------------------------
Last Update Date | 04/28/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 425 E 67TH ST DEPT. OF RADIATION ONCOLOGY
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10065-6004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-639-8194
-----------------------------------------------------
Fax | 646-422-2265
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 425 E 67TH ST DEPT. OF RADIATION ONCOLOGY
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10065-6004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-639-8194
-----------------------------------------------------
Fax | 646-422-2265
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NURSE PRACTITIONER
-----------------------------------------------------
Name | MRS. CHRISTINA A O'CONNOR
-----------------------------------------------------
Credential | N.P.
-----------------------------------------------------
Telephone | 212-639-8194
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number | F303228-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------