Healthcare Provider Details

I. General information

NPI: 1679893861
Provider Name (Legal Business Name): ONCOLOGY ASSOCIATES OF NORTH JERSEY LIMITED LIABILITY COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2010
Last Update Date: 06/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

361 FRANKLIN AVE
NUTLEY NJ
07110-1664
US

IV. Provider business mailing address

361 FRANKLIN AVE
NUTLEY NJ
07110-1664
US

V. Phone/Fax

Practice location:
  • Phone: 516-528-1388
  • Fax: 973-667-3002
Mailing address:
  • Phone: 516-528-1388
  • Fax: 973-667-3002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number25MA08749900
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number25MA08749900
License Number StateNJ

VIII. Authorized Official

Name: DR. IMTIAZ AHMED PATEL
Title or Position: DOCTOR
Credential: M.D
Phone: 516-528-1388