MEDICARE: SUSSEX RADIATION ONCOLOGY ASSOCIATES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1568461135
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUSSEX RADIATION ONCOLOGY ASSOCIATES

Provider Business Mailing Address
First Line	:	1143 NORTHERN BLVD
Second Line	:	#174
City	:	CLARKS SUMMIT
State	:	PA
Zip	:	18411-2221
Country	:	US
Telephone Number	:	570-451-3910
Fax Number	:	570-451-3236

Provider Business Practice Location Address
First Line	:	89 SPARTA AVE
Second Line	:
City	:	SPARTA
State	:	NJ
Zip	:	07871-1777
Country	:	US
Telephone Number	:	973-726-4180
Fax Number	:	973-726-4185

Authorized Official
Title or Position	:	RADIATION ONCOLOGIST
Name	:	MICHAEL J. GALLAGHER
Credential	:	M.D.
Telephone Number	:	973-726-4180

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	08/22/2020

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