Healthcare Provider Details

I. General information

NPI: 1740693407
Provider Name (Legal Business Name): WAYNE CANCER CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2014
Last Update Date: 06/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 HAMBURG TPKE.
WAYNE NJ
07470-2149
US

IV. Provider business mailing address

85 HARRISTOWN RD SECOND FLOOR
GLEN ROCK NJ
07452-3307
US

V. Phone/Fax

Practice location:
  • Phone: 973-310-0300
  • Fax: 201-855-8360
Mailing address:
  • Phone: 201-855-8360
  • Fax: 201-599-0777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN HAJJAR
Title or Position: OWNER
Credential: MD
Phone: 201-855-8302