Basic Information
| Provider Information | |||||||||
| NPI: | 1699737882 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MEMORIAL HOSPITAL FOR CANCER & ALLIED DISEASES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1275 YORK AVE | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100656007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2126392000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1275 YORK AVE | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100656007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2126392000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2006 | ||||||||
| LastUpdateDate: | 06/19/2008 | ||||||||
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| AuthorizedOfficialLastName: | GUNN | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2126396017 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | 7002020H | NY | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
ID Information
| ID | Type | State | Issuer | Description | 990082 | 01 | NY | CONNECTICARE ID# | OTHER | IC0144 | 01 | NY | HEALTHNET ID# | OTHER | 000019 | 01 | NY | BLUE CROSS ID# | OTHER | HO1586 | 01 | NY | OXFORD ID# | OTHER | 0009741 | 01 | NY | US HEALTHCARE ID# | OTHER | 0005044 | 01 | NY | WELLCARE ID# | OTHER | 00243467 | 05 | NY | MEDICAID | 330154 | 01 | NY | AMERIHEALTH ID# | OTHER |