Healthcare Provider Details

I. General information

NPI: 1972776672
Provider Name (Legal Business Name): HEMATOLOGY-ONCOLOGY ASSOCIATES OF NORTH JERSEY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2008
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 HIGHWAY 95 STE G73
BULLHEAD CITY AZ
86442-7860
US

IV. Provider business mailing address

3003 HIGHWAY 95 STE G73
BULLHEAD CITY AZ
86442-7860
US

V. Phone/Fax

Practice location:
  • Phone: 928-219-4560
  • Fax: 928-219-4561
Mailing address:
  • Phone: 928-219-4560
  • Fax: 928-219-4561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number6441700001
License Number StateAZ

VIII. Authorized Official

Name: DR. HAMDY A MOHTASEB
Title or Position: PRESIDENT/MEMBER
Credential: MD, FACP
Phone: 928-219-4560