Healthcare Provider Details

I. General information

NPI: 1205019064
Provider Name (Legal Business Name): ONCOMED PHARMACEUTICAL SERVICES OF JERSEY CITY NJ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2007
Last Update Date: 04/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4041 HADLEY RD
SOUTH PLAINFIELD NJ
07080-1111
US

IV. Provider business mailing address

1901 CAMPUS PL
LOUISVILLE KY
40299-2308
US

V. Phone/Fax

Practice location:
  • Phone: 201-798-5220
  • Fax: 201-798-5224
Mailing address:
  • Phone: 877-662-6633
  • Fax: 877-662-6355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number28RS00676800
License Number StateNJ

VIII. Authorized Official

Name: PAUL JARDINA
Title or Position: PRESIDENT & CEO
Credential:
Phone: 502-416-1483