1649279241 NPI number — INTENSITY MODULATED RADIATION THERAPY ASSOCIATES P C

Table of content: (NPI 1649279241)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649279241 NPI number — INTENSITY MODULATED RADIATION THERAPY ASSOCIATES P C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTENSITY MODULATED RADIATION THERAPY ASSOCIATES P C
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649279241
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 62254
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21264-2254
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-451-3910
Provider Business Mailing Address Fax Number:
570-451-3236

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
231 E BROWN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST STROUDSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18301-3005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-476-3488
Provider Business Practice Location Address Fax Number:
570-476-3473
Provider Enumeration Date:
07/18/2005

Additional Information

Authorized Official

Authorized Official Last Name:
GREENBERG
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
RADIATION ONCOLOGIST
Authorized Official Telephone Number:
570-476-3488

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 001730254 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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