Provider Demographics
NPI:1518998087
Name:CANCER CARE RADIOLOGY SYSTEMS
Entity Type:Organization
Organization Name:CANCER CARE RADIOLOGY SYSTEMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KYU
Authorized Official - Middle Name:H
Authorized Official - Last Name:SHIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-438-5486
Mailing Address - Street 1:810 DAVISON RD
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-5228
Mailing Address - Country:US
Mailing Address - Phone:716-438-5486
Mailing Address - Fax:716-438-0323
Practice Address - Street 1:810 DAVISON RD
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-5228
Practice Address - Country:US
Practice Address - Phone:716-438-5486
Practice Address - Fax:716-438-0323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY14456AMedicare ID - Type UnspecifiedMEDICARE