Healthcare Provider Details

I. General information

NPI: 1235236423
Provider Name (Legal Business Name): HEMATOLOGY ASSOC OF NJ PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 02/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 VALLEY HEALTH PLZ
PARAMUS NJ
07652-3628
US

IV. Provider business mailing address

1 VALLEY HEALTH PLZ
PARAMUS NJ
07652-3628
US

V. Phone/Fax

Practice location:
  • Phone: 201-634-5353
  • Fax:
Mailing address:
  • Phone: 201-634-5353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2816709
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer
# 2
IdentifierCB4007
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerRAILROAD MEDICARE

VIII. Authorized Official

Name: BARRY R FERNBACH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 201-634-5353