Healthcare Provider Details

I. General information

NPI: 1902852858
Provider Name (Legal Business Name): HORIZON HEMATOLOGY/ONCOLOGY CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 01/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 HAMBURG TPKE SUITE 202
WAYNE NJ
07470-8482
US

IV. Provider business mailing address

PO BOX 4630
WAYNE NJ
07474-4630
US

V. Phone/Fax

Practice location:
  • Phone: 973-790-3433
  • Fax:
Mailing address:
  • Phone: 201-512-9494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMA62887
License Number StateNJ

VIII. Authorized Official

Name: DR. REYAD MOHSEN
Title or Position: OWNER
Credential: MD
Phone: 973-790-3433