Healthcare Provider Details

I. General information

NPI: 1003874603
Provider Name (Legal Business Name): NBIMC DEPARTMENT OF ONCOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 LYONS AVE
NEWARK NJ
07112-2027
US

IV. Provider business mailing address

PO BOX 18214
NEWARK NJ
07191-8214
US

V. Phone/Fax

Practice location:
  • Phone: 973-926-7230
  • Fax: 973-926-9568
Mailing address:
  • Phone: 732-557-7160
  • Fax: 732-557-7109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ANTHONY ESPOSITO
Title or Position: DIRECTOR
Credential:
Phone: 732-557-7160