Provider Demographics
NPI:1770046351
Name:RALPH LAUREN CENTER FOR CANCER CARE AND PREVENTION
Entity Type:Organization
Organization Name:RALPH LAUREN CENTER FOR CANCER CARE AND PREVENTION
Other - Org Name:MEMORIAL SLOAN KETTERING CANCER CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:SENIOR VICE PRESIDENT, FINANCIAL PL
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:DIASIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-227-5978
Mailing Address - Street 1:1275 YORK AVE
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:212-639-2000
Mailing Address - Fax:
Practice Address - Street 1:1919 MADISON AVE FRNT 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035
Practice Address - Country:US
Practice Address - Phone:212-987-1777
Practice Address - Fax:212-987-1776
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEMORIAL HOSPITAL FOR CANCER AND ALLIED DISEASES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-10
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00243467Medicaid