Healthcare Provider Details

I. General information

NPI: 1316371453
Provider Name (Legal Business Name): MEADOWLANDS CANCER CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2013
Last Update Date: 08/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 MEADOWLANDS PKWY
SECAUCUS NJ
07094-2977
US

IV. Provider business mailing address

2 LAKE ST C/O TURBO DOG CLAIMS
MONROE NY
10950-3542
US

V. Phone/Fax

Practice location:
  • Phone: 845-837-1388
  • Fax: 845-837-1389
Mailing address:
  • Phone: 845-837-1388
  • Fax: 845-837-1389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QX0200X
TaxonomyOncology Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QX0203X
TaxonomyRadiation Oncology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. THOMAS R EANELLI
Title or Position: MEMBER
Credential: MD
Phone: 845-695-5999