Healthcare Provider Details

I. General information

NPI: 1528499290
Provider Name (Legal Business Name): REGIONAL CANCER CARE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2013
Last Update Date: 12/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 2ND ST
HACKENSACK NJ
07601-2191
US

IV. Provider business mailing address

100 1ST ST SUITE 301
HACKENSACK NJ
07601-2153
US

V. Phone/Fax

Practice location:
  • Phone: 551-996-5900
  • Fax: 551-996-9246
Mailing address:
  • Phone: 201-883-0900
  • Fax: 201-883-0175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number25MA09266500
License Number StateNJ

VII. Legacy identifiers

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

VIII. Authorized Official

Name: CAROL G SCHLUTER
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 201-996-5850