Healthcare Provider Details

I. General information

NPI: 1477515740
Provider Name (Legal Business Name): GYNECOLOGIC CANCER & PELVIC SURGERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 OLD SHORT HILLS RD STE 400
WEST ORANGE NJ
07052-1000
US

IV. Provider business mailing address

101 OLD SHORT HILLS RD STE 400
WEST ORANGE NJ
07052-1000
US

V. Phone/Fax

Practice location:
  • Phone: 973-243-9300
  • Fax: 973-325-8573
Mailing address:
  • Phone: 973-243-9300
  • Fax: 973-325-8573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number25MA04766500
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number
License Number StateNJ

VIII. Authorized Official

Name: THAD R DENEHY
Title or Position: PROVIDERS
Credential: MD
Phone: 973-243-9300