Provider Demographics
NPI:1255654463
Name:MSKCC
Entity Type:Organization
Organization Name:MSKCC
Other - Org Name:MSKCC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MS
Authorized Official - First Name:SWATI
Authorized Official - Middle Name:
Authorized Official - Last Name:DE-DAS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:212-610-0117
Mailing Address - Street 1:4129 MORGAN ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11363-1722
Mailing Address - Country:US
Mailing Address - Phone:718-631-5059
Mailing Address - Fax:
Practice Address - Street 1:160 E 53RD ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-5243
Practice Address - Country:US
Practice Address - Phone:212-610-0117
Practice Address - Fax:212-588-1343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-03
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046373284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========Medicare UPIN