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General NPI Number Information
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NPI Number | 1316275266
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Entity Type | Organization
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Legal Business Name | JERSEY HEMEONC LLC
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Dates
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Enumeration Date | 12/03/2009
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 2000 WEST ST STE 205
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City | UNION CITY
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State | NJ
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Zip | 07087-4791
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Country | US
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Telephone | 201-751-4004
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Fax | 201-455-6296
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Provider Business Mailing Address
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Address Line | PO BOX 252
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City | WOOD RIDGE
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State | NJ
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Zip | 07075-0252
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Country | US
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Telephone | 201-751-4004
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Fax | 201-455-6296
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Authorized Official
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Title or Position | OWNER
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Name | BHAVNA GUPTA
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Credential |
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Telephone | 201-751-4004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RX0202X
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Taxonomy Name | Medical Oncology Physician
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License Number | 25MA08324400
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License Number State | NJ
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