Healthcare Provider Details

I. General information

NPI: 1053441071
Provider Name (Legal Business Name): IYENGAR HEMATOLOGY ONCOLOGY MEDICAL CENTER PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 09/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 E 29TH ST
BAYONNE NJ
07002-4654
US

IV. Provider business mailing address

PO BOX 1579
LIVINGSTON NJ
07039-7179
US

V. Phone/Fax

Practice location:
  • Phone: 201-858-1211
  • Fax: 201-858-4171
Mailing address:
  • Phone: 201-858-1211
  • Fax: 201-858-4171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: REKHA D IYENGAR
Title or Position: GENERAL MANAGER
Credential: MD
Phone: 201-858-1211