Basic Information
Provider Information
NPI: 1982840039
EntityType: 2
ReplacementNPI:  
OrganizationName: RADIATION SERVICES OF GREENWICH, LLC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
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OtherFirstName:  
OtherMiddleName:  
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Mailing Information
Address1: 77 LAFAYETTE PL
Address2:  
City: GREENWICH
State: CT
PostalCode: 068305426
CountryCode: US
TelephoneNumber: 2038633773
FaxNumber: 2038633723
Practice Location
Address1: 77 LAFAYETTE PL
Address2:  
City: GREENWICH
State: CT
PostalCode: 068305426
CountryCode: US
TelephoneNumber: 2038633773
FaxNumber: 2038633723
Other Information
ProviderEnumerationDate: 12/19/2008
LastUpdateDate: 12/19/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: SNELLING
AuthorizedOfficialFirstName: LESLEY
AuthorizedOfficialMiddleName: C.
AuthorizedOfficialTitleorPosition: PRESIDENT
AuthorizedOfficialTelephone: 2038633773
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: DR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: M.D.
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2085R0001X034877CTY193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology

No ID Information.


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