Healthcare Provider Details

I. General information

NPI: 1346249174
Provider Name (Legal Business Name): GAMMA-ELECTRON RADIATION ONCOLOGY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 OVERLOOK RD 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 NumberMA29760
License Number StateNJ

VIII. Authorized Official

Name: ROY C CABRERA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 908-754-7711