Provider Demographics
NPI:1720087083
Name:RADIATION ONCOLOGY SERVICES PC
Entity Type:Organization
Organization Name:RADIATION ONCOLOGY SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:FALLON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:607-758-2360
Mailing Address - Street 1:1088 COMMONS AVE
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045-1644
Mailing Address - Country:US
Mailing Address - Phone:607-758-2360
Mailing Address - Fax:607-758-2364
Practice Address - Street 1:1088 COMMONS AVE
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-1644
Practice Address - Country:US
Practice Address - Phone:607-758-2360
Practice Address - Fax:607-758-2364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY197667174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG62364Medicare UPIN
NYBA0382Medicare ID - Type Unspecified