Healthcare Provider Details

I. General information

NPI: 1255412359
Provider Name (Legal Business Name): REGIONAL CANCER CARE ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 04/21/2024
Certification Date: 04/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 PROFESSIONAL VIEW DR
FREEHOLD NJ
07728-7904
US

IV. Provider business mailing address

326 PROFESSIONAL VIEW DR
FREEHOLD NJ
07728-7904
US

V. Phone/Fax

Practice location:
  • Phone: 732-431-8400
  • Fax: 732-431-0114
Mailing address:
  • Phone: 732-431-8400
  • Fax: 732-431-0114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMA42131
License Number StateNJ

VIII. Authorized Official

Name: TERRILL JORDAN
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 201-510-0910