Healthcare Provider Details

I. General information

NPI: 1033249073
Provider Name (Legal Business Name): COLANTA HEMATOLOGY & ONCOLOGY CTR INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

564 BROADWAY
BAYONNE NJ
07002-3825
US

IV. Provider business mailing address

22 MERIDIAN RD UNIT 7
EDISON NJ
08820-2848
US

V. Phone/Fax

Practice location:
  • Phone: 201-823-0243
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: ROHIT GUPTA
Title or Position: BILLING MANAGER
Credential:
Phone: 732-321-1100