Healthcare Provider Details

I. General information

NPI: 1770284820
Provider Name (Legal Business Name): REGIONAL CANCER CARE ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2023
Last Update Date: 04/21/2024
Certification Date: 04/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 WHITE RD STE 106
LITTLE SILVER NJ
07739-1166
US

IV. Provider business mailing address

500 FRANK W BURR BLVD STE 560
TEANECK NJ
07666-6804
US

V. Phone/Fax

Practice location:
  • Phone: 732-889-8420
  • Fax:
Mailing address:
  • Phone: 844-301-4158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ZI0100X
TaxonomyImmunopathology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

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