Healthcare Provider Details

I. General information

NPI: 1700483252
Provider Name (Legal Business Name): HEMATOLOGY ONCOLOGY ASSOCIATES OF NORTH JERSEY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2020
Last Update Date: 10/07/2020
Certification Date: 10/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 HANCOCK RD SUITE 204
BULLHEAD CITY AZ
86442
US

IV. Provider business mailing address

3900 STOCKTON HILL ROAD SUITE B368
KINGMAN AZ
86409
US

V. Phone/Fax

Practice location:
  • Phone: 928-219-4560
  • Fax: 928-219-4561
Mailing address:
  • Phone: 928-681-1234
  • Fax: 928-681-1811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: HAMDY A. MOHTASEB
Title or Position: PRESIDENT
Credential: MD
Phone: 928-681-1234