Healthcare Provider Details

I. General information

NPI: 1104814060
Provider Name (Legal Business Name): ROY C CABRERA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 OVERLOOK RD SUITE L-05
SUMMIT NJ
07901-3570
US

IV. Provider business mailing address

PO BOX 4127
WARREN NJ
07059-0127
US

V. Phone/Fax

Practice location:
  • Phone: 908-522-2871
  • Fax: 908-522-5628
Mailing address:
  • Phone: 908-754-7711
  • Fax: 908-754-8885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number25MA02976000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: