Healthcare Provider Details

I. General information

NPI: 1639630973
Provider Name (Legal Business Name): IYENGAR HEMATOLOGY ONCOLOGY MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2019
Last Update Date: 03/28/2019
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:
Mailing address:
  • Phone: 201-858-1211
  • 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: REKHA IYENGAR
Title or Position: MEMBER
Credential:
Phone: 201-858-1211