Healthcare Provider Details

I. General information

NPI: 1568461135
Provider Name (Legal Business Name): SUSSEX RADIATION ONCOLOGY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89 SPARTA AVE
SPARTA NJ
07871-1777
US

IV. Provider business mailing address

1143 NORTHERN BLVD #174
CLARKS SUMMIT PA
18411-2221
US

V. Phone/Fax

Practice location:
  • Phone: 973-726-4180
  • Fax: 973-726-4185
Mailing address:
  • Phone: 570-451-3910
  • Fax: 570-451-3236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL J. GALLAGHER
Title or Position: RADIATION ONCOLOGIST
Credential: M.D.
Phone: 973-726-4180