Basic Information
| Provider Information | |||||||||
| NPI: | 1720299555 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NEW YORK RADIATION ASSOCIATES, P.C. | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 106-14 70TH AVENUE | ||||||||
| Address2: | |||||||||
| City: | FOREST HILLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113755607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185206620 | ||||||||
| FaxNumber: | 7185206630 | ||||||||
| Practice Location | |||||||||
| Address1: | 106-14 70TH AVENUE | ||||||||
| Address2: | |||||||||
| City: | FOREST HILLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113755607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185206620 | ||||||||
| FaxNumber: | 7185206630 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2007 | ||||||||
| LastUpdateDate: | 01/26/2015 | ||||||||
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| AuthorizedOfficialLastName: | LIPSZTEIN | ||||||||
| AuthorizedOfficialFirstName: | ROBERTO | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7185206620 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 85A362 | 01 | NY | EMPIRE MEDICARE | OTHER | 00863H | 01 | NY | GHI MEDICARE | OTHER | 04373I | 01 | NY | GHI MEDICARE | OTHER | 00863G | 01 | NY | GHI MEDICARE | OTHER | 324641 | 01 | NY | EMPIRE MEDICARE | OTHER |