Healthcare Provider Details

I. General information

NPI: 1780874271
Provider Name (Legal Business Name): PREMIER ONCOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2007
Last Update Date: 10/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 W JIMMIE LEEDS RD SUITE 11
GALLOWAY NJ
08205-9438
US

IV. Provider business mailing address

54 W JIMMIE LEEDS RD SUITE 11
GALLOWAY NJ
08205-9438
US

V. Phone/Fax

Practice location:
  • Phone: 609-748-1001
  • Fax: 609-748-1002
Mailing address:
  • Phone: 609-748-1001
  • Fax: 609-748-1002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number25MA07573400
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number25MA07573400
License Number StateNJ

VIII. Authorized Official

Name: RAJASREE AJAY
Title or Position: PHYSICIAN
Credential:
Phone: 609-748-1001