Provider Demographics
NPI:1033163506
Name:BROOKLYN RADIATION ONCOLOGY PC
Entity Type:Organization
Organization Name:BROOKLYN RADIATION ONCOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD,CEO
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOTNICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-335-4067
Mailing Address - Street 1:PO BOX 6054
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34611-6054
Mailing Address - Country:US
Mailing Address - Phone:917-688-2534
Mailing Address - Fax:800-420-3318
Practice Address - Street 1:2101 AVENUE X
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-2910
Practice Address - Country:US
Practice Address - Phone:718-517-2900
Practice Address - Fax:800-420-3318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02644640Medicaid
NYDF6854OtherRR MEDICARE
NYDF6854OtherRR MEDICARE