Healthcare Provider Details

I. General information

NPI: 1811263510
Provider Name (Legal Business Name): REGIONAL CANCER CARE ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2012
Last Update Date: 04/21/2024
Certification Date: 04/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 SECOND STREET
HACKENSACK NJ
07601
US

IV. Provider business mailing address

100 FIRST STREET SUITE 302
HACKENSACK NJ
07601
US

V. Phone/Fax

Practice location:
  • Phone: 201-996-5900
  • Fax: 201-996-9246
Mailing address:
  • Phone: 201-996-5850
  • Fax: 201-336-8578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

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