Healthcare Provider Details

I. General information

NPI: 1346688850
Provider Name (Legal Business Name): GARDEN STATE RADIATION ONCOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2013
Last Update Date: 06/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 LAKEHURST RD
TOMS RIVER NJ
08755-8021
US

IV. Provider business mailing address

512 LAKEHURST RD
TOMS RIVER NJ
08755-8021
US

V. Phone/Fax

Practice location:
  • Phone: 732-849-0077
  • Fax:
Mailing address:
  • Phone: 732-849-0077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DHARAM MANN
Title or Position: OWNER
Credential: M.D
Phone: 732-849-0077