New York Radiation Oncology Associates, PC

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

NEW YORK RADIATION ONCOLOGY ASSOCIATES, PC

Practice address

92-02 Liberty Avenue
Ozone Park, NY 11417

Phone

(718) 835-9729

Fax

(718) 925-9817

NPI assigned

May 3, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Rene S Mediavillo, M.D.NPI 1376622019

Title

Owner

Phone

(718) 835-9729

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Rene S Mediavillo, M.D.

  • Specialist
  • Ozone Park, NY
  • NPI 1376622019
  Medicare reassignment NPD Authorized official
• Joseph G Monge, MD

  • Radiation Oncology Physician
  • West Islip, NY
  • NPI 1932145752
  NPD (past)
• Edward E Mullen, MD

  • Radiation Oncology Physician
  • Oceanside, NY
  • NPI 1104824606

  Specialist

  NPD (past)
• Leslie E Botnick, M.D.

  • Radiation Oncology Physician
  • Sherman Oaks, CA
  • NPI 1275530917

  Specialist

  NPD (past)
• May Lim, MD

  • Radiation Oncology Physician
  • Raleigh, NC
  • NPI 1376516823
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1215159603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "92-02 LIBERTY AVENUE",
            "city": "OZONE PARK",
            "state": "NY",
            "postal_code": "11417",
            "telephone_number": "718-835-9729",
            "fax_number": "718-925-9817"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "92-02 LIBERTY AVENUE",
            "city": "OZONE PARK",
            "state": "NY",
            "postal_code": "11417",
            "telephone_number": "718-835-9729",
            "fax_number": "718-925-9817"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW YORK RADIATION ONCOLOGY ASSOCIATES, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MEDIAVILLO",
        "authorized_official_first_name": "RENE",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "718-835-9729",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02146674",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Ozone Park, NY
• Providers in Ozone Park, NY by specialty
• Specialist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.