Provider Demographics
NPI:1518956176
Name:BROOME ONCOLOGY LLC
Entity Type:Organization
Organization Name:BROOME ONCOLOGY LLC
Other - Org Name:BROOME ONCOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LEAD PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MADHURI
Authorized Official - Middle Name:
Authorized Official - Last Name:YALAMANCHILI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:607-763-6850
Mailing Address - Street 1:30 HARRISON ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-2161
Mailing Address - Country:US
Mailing Address - Phone:607-763-6850
Mailing Address - Fax:607-763-6703
Practice Address - Street 1:30 HARRISON ST
Practice Address - Street 2:SUITE 100
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790-2161
Practice Address - Country:US
Practice Address - Phone:607-763-6850
Practice Address - Fax:607-763-6703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-17
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02202871Medicaid
NY4439690001Medicare NSC
NY02202871Medicaid