Healthcare Provider Details

I. General information

NPI: 1851859136
Provider Name (Legal Business Name): REGIONAL CANCER CARE ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2019
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 WOODPORT RD
SPARTA NJ
07871-2625
US

IV. Provider business mailing address

500 FRANK W BURR BLVD STE 560
TEANECK NJ
07666-6804
US

V. Phone/Fax

Practice location:
  • Phone: 973-726-0005
  • Fax:
Mailing address:
  • Phone: 201-510-0910
  • Fax:

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: TERRILL JORDAN
Title or Position: PRESIDENT
Credential:
Phone: 201-510-0910