Provider Demographics
NPI:1598766164
Name:WHITE PLAINS RADIATION THERAPY
Entity Type:Organization
Organization Name:WHITE PLAINS RADIATION THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:T
Authorized Official - Last Name:KHOURY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-681-1219
Mailing Address - Street 1:2 LONGVIEW AVE
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-5002
Mailing Address - Country:US
Mailing Address - Phone:914-681-2727
Mailing Address - Fax:914-681-2795
Practice Address - Street 1:2 LONGVIEW AVE
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-5002
Practice Address - Country:US
Practice Address - Phone:914-681-2727
Practice Address - Fax:914-681-2795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1761212085R0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWK8591Medicare PIN