Provider Demographics
NPI:1013131903
Name:GREENWICH RADIATION ONCOLOGY
Entity Type:Organization
Organization Name:GREENWICH RADIATION ONCOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF RADIATION ONCOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:FASS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-848-8950
Mailing Address - Street 1:1 THEALL ROAD
Mailing Address - Street 2:STE 107
Mailing Address - City:RYE
Mailing Address - State:NY
Mailing Address - Zip Code:10580
Mailing Address - Country:US
Mailing Address - Phone:914-848-8950
Mailing Address - Fax:914-848-8951
Practice Address - Street 1:1 THEALL ROAD
Practice Address - Street 2:STE 107
Practice Address - City:RYE
Practice Address - State:NY
Practice Address - Zip Code:10580
Practice Address - Country:US
Practice Address - Phone:914-848-8950
Practice Address - Fax:914-848-8951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0321912085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTA65178Medicare UPIN
CT009015606Medicare ID - Type Unspecified