Healthcare Provider Details

I. General information

NPI: 1801850243
Provider Name (Legal Business Name): REGIONAL CANCER CARE ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 04/21/2024
Certification Date: 04/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 BEY LEA RD STE A202
TOMS RIVER NJ
08753-2900
US

IV. Provider business mailing address

500 FRANK W BURR BLVD STE 560- MAILBOX #29
TEANECK NJ
07666
US

V. Phone/Fax

Practice location:
  • Phone: 732-367-1535
  • Fax:
Mailing address:
  • Phone: 201-510-0910
  • Fax: 201-621-6931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number00042753
License Number StateNJ
# 4
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