Healthcare Provider Details

I. General information

NPI: 1720454564
Provider Name (Legal Business Name): COMMUNITY CANCER CENTERS OF AMERICA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2015
Last Update Date: 08/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

691 STATE HIGHWAY 33
TRENTON NJ
08619
US

IV. Provider business mailing address

691 STATE HIGHWAY 33
TRENTON NJ
08619
US

V. Phone/Fax

Practice location:
  • Phone: 201-215-5535
  • Fax: 844-241-7242
Mailing address:
  • Phone: 201-215-5535
  • Fax: 844-241-7242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMA38585
License Number StateNJ

VIII. Authorized Official

Name: MR. PANKAJ K AKSHAY
Title or Position: BILLING MANAGER
Credential:
Phone: 201-215-5535