Healthcare Provider Details

I. General information

NPI: 1518232586
Provider Name (Legal Business Name): REGIONAL CANCER CARE ASSOCIATES LLC
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

210 S SHORE RD SUITE 106
MARMORA NJ
08223-1200
US

IV. Provider business mailing address

25 MAIN ST STE 502
HACKENSACK NJ
07601-7082
US

V. Phone/Fax

Practice location:
  • Phone: 609-390-7888
  • Fax: 609-390-2614
Mailing address:
  • Phone: 201-510-0910
  • Fax: 201-880-8774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

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