Healthcare Provider Details

I. General information

NPI: 1134493489
Provider Name (Legal Business Name): CNIJ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2012
Last Update Date: 05/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 LITTLE ALBANY ST
NEW BRUNSWICK NJ
08901-1914
US

IV. Provider business mailing address

195 LITTLE ALBANY ST
NEW BRUNSWICK NJ
08901-1914
US

V. Phone/Fax

Practice location:
  • Phone: 732-235-9839
  • Fax: 732-235-9831
Mailing address:
  • Phone: 732-235-9839
  • Fax: 732-235-9831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0200X
TaxonomyOncology Clinic/Center
License Number26NJ00320200
License Number StateNJ

VIII. Authorized Official

Name: MRS. NATALIE DENISE RALPH-NELSON
Title or Position: APN
Credential: APN
Phone: 732-235-9839