Provider Demographics
NPI:1427039320
Name:RADIATION ONCOLOGY MEDICAL PRACTICE OF ST VINCENTS PC
Entity Type:Organization
Organization Name:RADIATION ONCOLOGY MEDICAL PRACTICE OF ST VINCENTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:M
Authorized Official - Last Name:BERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-576-9800
Mailing Address - Street 1:PO BOX 26179
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-6179
Mailing Address - Country:US
Mailing Address - Phone:770-693-6022
Mailing Address - Fax:770-693-6039
Practice Address - Street 1:325 W 15TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-5903
Practice Address - Country:US
Practice Address - Phone:212-604-6081
Practice Address - Fax:212-367-1742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-08
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02039870Medicaid
W33851Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER