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NPI Code Detail

MEDICARE: QUEENS MEDICAL RADIOTHERAPY PC

MEDICARE: QUEENS MEDICAL RADIOTHERAPY PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0001XRadiation Oncology Physician

General Provider Information

NPI Number : 1043518905
Entity Type Code : Organization
Provider Name (Legal Business Name) : QUEENS MEDICAL RADIOTHERAPY PC
Provider Business Mailing Address
First Line : PO BOX 10050
Second Line :
City : MANHATTAN BEACH
State : CA
Zip : 90267-7550
Country : US
Telephone Number : 310-335-4000
Fax Number : 310-335-4098
Provider Business Practice Location Address
First Line : 15806 NORTHERN BLVD
Second Line :
City : FLUSHING
State : NY
Zip : 11358-1641
Country : US
Telephone Number : 718-445-3700
Fax Number : 718-460-4051
Authorized Official
Title or Position : MEDICAL DIRECTOR
Name : LESLIE BOTNICK
Credential : M.D.
Telephone Number : 310-335-4000
Provider Enumeration Date : 03/02/2011
Last Update Date : 03/02/2011

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Directions to “QUEENS MEDICAL RADIOTHERAPY PC ” Practice Location

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