Healthcare Provider Details

I. General information

NPI: 1245484450
Provider Name (Legal Business Name): CANCERCARE OF SOUTHERN NEW JERSEY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2008
Last Update Date: 04/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 HADDONFIELD RD SUITE 145
CHERRY HILL NJ
08002-4801
US

IV. Provider business mailing address

2160 COLONIAL BLVD
FORT MYERS FL
33907-1410
US

V. Phone/Fax

Practice location:
  • Phone: 856-488-4224
  • Fax: 856-488-8050
Mailing address:
  • Phone: 239-931-7212
  • Fax: 239-931-7385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL J. KATIN
Title or Position: CEO/PRESIDENT
Credential: MD
Phone: 239-931-7275