Provider Demographics
NPI:1568403996
Name:MEMORIAL SLOAN KETTERING CANCER CTR
Entity Type:Organization
Organization Name:MEMORIAL SLOAN KETTERING CANCER CTR
Other - Org Name:MEMORIAL HOSP OPD AT 68TH ST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MURILLO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:212-639-2206
Mailing Address - Street 1:1275 YORK AVE RM H-313
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-6007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:444 E 68TH ST
Practice Address - Street 2:ROOM C164
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065
Practice Address - Country:US
Practice Address - Phone:646-888-0730
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEMORIAL HOSPITAL FOR CANCER & ALLIED DISEASES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-09
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003945333600000X
3336C0002X, 3336C0003X, 3336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00243467Medicaid
3356347OtherOTHER ID NUMBER-COMMERCIAL NUMBER
NY00243467Medicaid