Healthcare Provider Details

I. General information

NPI: 1275808248
Provider Name (Legal Business Name): REGIONAL CANCER CARE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2012
Last Update Date: 04/21/2024
Certification Date: 04/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

723 N BEERS ST SUITE 1E
HOLMDEL NJ
07733-1517
US

IV. Provider business mailing address

326 PROFESSIONAL VIEW DR BLDG 300
FREEHOLD NJ
07728-7904
US

V. Phone/Fax

Practice location:
  • Phone: 732-739-8644
  • Fax: 732-739-4438
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 Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

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