Provider Demographics
NPI:1184633513
Name:RICHMOND CANCER AND BLOOD DISORDERS P.C.
Entity Type:Organization
Organization Name:RICHMOND CANCER AND BLOOD DISORDERS P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SEETHA
Authorized Official - Middle Name:R
Authorized Official - Last Name:MURUKUTLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-979-2523
Mailing Address - Street 1:15 OLD FARMERS LN
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-1439
Mailing Address - Country:US
Mailing Address - Phone:718-979-2523
Mailing Address - Fax:718-273-3114
Practice Address - Street 1:1384 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-3908
Practice Address - Country:US
Practice Address - Phone:718-273-2277
Practice Address - Fax:718-273-3114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY151450207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWBW251Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER