Provider Demographics
NPI:1952619181
Name:TRIBECA RADIATION PLLC
Entity Type:Organization
Organization Name:TRIBECA RADIATION PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:BERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-925-8882
Mailing Address - Street 1:PO BOX 417035
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-7035
Mailing Address - Country:US
Mailing Address - Phone:212-925-8882
Mailing Address - Fax:
Practice Address - Street 1:408-410 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4111
Practice Address - Country:US
Practice Address - Phone:212-925-8882
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-22
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03290246Medicaid
NY03290246Medicaid