Provider Demographics
NPI:1720273261
Name:SURGICAL ONCOLOGY ASSOCIATES
Entity Type:Organization
Organization Name:SURGICAL ONCOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:RENE
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:KHAFIF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-376-6580
Mailing Address - Street 1:2219 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-2303
Mailing Address - Country:US
Mailing Address - Phone:718-376-6580
Mailing Address - Fax:718-376-6597
Practice Address - Street 1:2219 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-2303
Practice Address - Country:US
Practice Address - Phone:718-376-6580
Practice Address - Fax:718-376-6597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-07
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY091233174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW2L221Medicare PIN