Healthcare Provider Details

I. General information

NPI: 1841243771
Provider Name (Legal Business Name): VALLEY RADIATION ONCOLOGY ASSOC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 08/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 N VAN DIEN AVE
RIDGEWOOD NJ
07450-2726
US

IV. Provider business mailing address

109 WANAQUE AVE
POMPTON LAKES NJ
07442-2101
US

V. Phone/Fax

Practice location:
  • Phone: 201-634-5403
  • Fax: 862-666-9204
Mailing address:
  • Phone: 862-666-9200
  • Fax: 862-666-9204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL WESSON
Title or Position: DIRECTOR
Credential: M.D.
Phone: 862-666-9200