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General NPI Number Information
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NPI Number | 1124257753
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Entity Type | Organization
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Legal Business Name | HEMATOLOGY-ONCOLOGY PROFESSIONAL OF WAYNE
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Dates
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Enumeration Date | 07/02/2009
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Last Update Date | 07/08/2009
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Provider Practice Location Address
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Address Line | 8028 BRITTANY DR
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City | WAYNE
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State | NJ
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Zip | 07470-3297
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Country | US
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Telephone | 973-773-2039
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4237
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City | CLIFTON
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State | NJ
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Zip | 07012-4237
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Country | US
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Telephone | 973-773-2039
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | PEYMAN MAGHSOUDLOU
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Credential |
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Telephone | 973-773-2039
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0000X
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Taxonomy Name | Hematology (Internal Medicine) Physician
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License Number |
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License Number State |
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