MEDICARE: BAYONNE RADIATION ONCOLOGY ASSOCIATES, LLC

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	2085R0001X	Radiation Oncology Physician

General Provider Information

NPI Number	:	1902858020
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAYONNE RADIATION ONCOLOGY ASSOCIATES, LLC

Provider Business Mailing Address
First Line	:	27 E 29TH ST
Second Line	:
City	:	BAYONNE
State	:	NJ
Zip	:	07002-4654
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 LETHBRIDGE PLZ
Second Line	:	ROUTE 17 NORTH, SUITE #20
City	:	MAHWAH
State	:	NJ
Zip	:	07430-2126
Country	:	US
Telephone Number	:	201-684-1616
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MICHAEL WESSON
Credential	:	M.D.
Telephone Number	:	201-684-1616

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	08/22/2020

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