1902877467 NPI number — MEMORIAL SLOAN-KETTERING CANCER CENTER PHYSICIANS AT PHELPS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902877467 NPI number — MEMORIAL SLOAN-KETTERING CANCER CENTER PHYSICIANS AT PHELPS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEMORIAL SLOAN-KETTERING CANCER CENTER PHYSICIANS AT PHELPS
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:
6
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:
1902877467
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
633 3RD AVE
Provider Second Line Business Mailing Address:
BOX 3
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10017-6706
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
777 N BROADWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SLEEPY HOLLOW
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10591-1000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-639-2000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ANDREOZZI
Authorized Official First Name:
SALVATORE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
ASSOCIATE DIRECTOR
Authorized Official Telephone Number:
646-227-3751

Provider Taxonomy Codes

  • Taxonomy code: 207RX0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085R0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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