Basic Information
| Provider Information | |||||||||
| NPI: | 1639140254 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SEAGATE RADIATION ONCOLOGY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3838 NEPTUNE AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112241328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7183720263 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3632 NOSTRAND AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112295303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7183324409 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2006 | ||||||||
| LastUpdateDate: | 04/02/2008 | ||||||||
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| AuthorizedOfficialLastName: | HALPERN | ||||||||
| AuthorizedOfficialFirstName: | JOSHUA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7183720263 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
No ID Information.