Provider Demographics
NPI:1861479248
Name:RALPH LAUREN CENTER FOR CANCER CARE AND PREVENTION
Entity type:Organization
Organization Name:RALPH LAUREN CENTER FOR CANCER CARE AND PREVENTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE CYCLE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MILLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BENITEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-987-1777
Mailing Address - Street 1:1919 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-2745
Mailing Address - Country:US
Mailing Address - Phone:212-987-1777
Mailing Address - Fax:212-987-1776
Practice Address - Street 1:1919 MADISON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-2745
Practice Address - Country:US
Practice Address - Phone:212-987-1777
Practice Address - Fax:212-987-1776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2017-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7002172R174400000X, 261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02424633Medicaid