Healthcare Provider Details

I. General information

NPI: 1992071864
Provider Name (Legal Business Name): REGIONAL CANCER CARE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2012
Last Update Date: 04/21/2024
Certification Date: 04/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 YOUNG AVE STE 200
MOORESTOWN NJ
08057-3146
US

IV. Provider business mailing address

25 MAIN ST STE 601
HACKENSACK NJ
07601-7083
US

V. Phone/Fax

Practice location:
  • Phone: 609-702-1900
  • Fax: 609-702-8455
Mailing address:
  • Phone: 201-510-0910
  • Fax: 609-702-8455

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
Credential:
Phone: 201-510-0910