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NPI Code Detail

MEDICARE: RADIATION ONCOLOGY MEDICAL PRACTICE OF ST VINCENTS PC

MEDICARE: RADIATION ONCOLOGY MEDICAL PRACTICE OF ST VINCENTS 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

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1427039320
Entity Type Code : Organization
Provider Name (Legal Business Name) : RADIATION ONCOLOGY MEDICAL PRACTICE OF ST VINCENTS PC
Provider Business Mailing Address
First Line : PO BOX 26179
Second Line :
City : NEW YORK
State : NY
Zip : 10087-6179
Country : US
Telephone Number : 770-693-6022
Fax Number : 770-693-6039
Provider Business Practice Location Address
First Line : 325 W 15TH ST
Second Line :
City : NEW YORK
State : NY
Zip : 10011-5903
Country : US
Telephone Number : 212-604-6081
Fax Number : 212-367-1742
Authorized Official
Title or Position : PRESIDENT
Name : ANTHONY M BERSON
Credential : M.D.
Telephone Number : 212-576-9800
Provider Enumeration Date : 11/08/2005
Last Update Date : 09/13/2011

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