Provider Demographics
NPI:1902109713
Name:SOUTH NASSAU ONCOLOGY, PC
Entity Type:Organization
Organization Name:SOUTH NASSAU ONCOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-632-3303
Mailing Address - Street 1:1115 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PLEASANT VIEW
Mailing Address - State:TN
Mailing Address - Zip Code:37146-8136
Mailing Address - Country:US
Mailing Address - Phone:866-353-0360
Mailing Address - Fax:615-523-2882
Practice Address - Street 1:1 HEALTHY WAY
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-1551
Practice Address - Country:US
Practice Address - Phone:516-632-3303
Practice Address - Fax:516-632-3325
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTH SHORE RADIATION ONCOLOGY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-12-16
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty