Provider Demographics
NPI:1235107871
Name:KANTOFF, PHILIP W (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:W
Last Name:KANTOFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 YORK AVE
Mailing Address - Street 2:SUITE C-1289
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-6007
Mailing Address - Country:US
Mailing Address - Phone:212-639-5393
Mailing Address - Fax:
Practice Address - Street 1:1275 YORK AVE
Practice Address - Street 2:SUITE C-1289
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-6007
Practice Address - Country:US
Practice Address - Phone:212-639-5393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2015-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY147233-1207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
3042561OtherMASSHEALTH MA MEDICAID
2065253OtherAETNA US HEALTHCARE
6000195OtherCIGNA
D67904DFOtherHPHC DFCI ONLY
MAJ08074OtherBCBS INDEMITY BC ELECT HM
731514OtherTUFTS
44290OtherFALLON COMMUNITY HEALTH P
830003272OtherRR MEDICARE DFCI
3042561OtherMASSHEALTH MA MEDICAID
J08074Medicare ID - Type Unspecified