Healthcare Provider Details

I. General information

NPI: 1881078889
Provider Name (Legal Business Name): HEMATOLOGY ONCOLOGY ASSOCIATES OF NORTH JERSEY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2015
Last Update Date: 07/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5225 S HIGHWAY 95 SUITE 6
FORT MOHAVE AZ
86426-9111
US

IV. Provider business mailing address

3900 STOCKTON HILL RD SUITE B368
KINGMAN AZ
86409-3029
US

V. Phone/Fax

Practice location:
  • Phone: 928-770-4560
  • Fax: 928-770-4561
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 / OWNER
Credential: MD
Phone: 928-279-3838