Healthcare Provider Details

I. General information

NPI: 1275098022
Provider Name (Legal Business Name): REGIONAL CANCER CARE ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2019
Last Update Date: 02/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 VERONICA AVE STE 201
SOMERSET NJ
08873-5002
US

IV. Provider business mailing address

J2 BRIER HILL CT
EAST BRUNSWICK NJ
08816-3340
US

V. Phone/Fax

Practice location:
  • Phone: 732-246-4882
  • Fax: 732-249-5633
Mailing address:
  • Phone: 732-390-7750
  • Fax: 732-390-4628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: EDWARD J LICITRA
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 732-390-7750