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General NPI Number Information
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NPI Number | 1568630903
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Entity Type | Organization
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Legal Business Name | PROGRESSIVE RADIATION ONCOLOGY
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Dates
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Enumeration Date | 02/19/2008
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Last Update Date | 02/19/2008
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Provider Practice Location Address
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Address Line | 30 REHILL AVE
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City | SOMERVILLE
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State | NJ
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Zip | 08876-2500
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Country | US
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Telephone | 973-322-4212
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Fax | 973-322-4132
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Provider Business Mailing Address
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Address Line | PO BOX 659
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City | MILLBURN
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State | NJ
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Zip | 07041-0659
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Country | US
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Telephone | 973-322-4212
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Fax | 973-322-4132
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Authorized Official
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Title or Position | RADIATION ONCOLOGIST
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Name | LAURA BOND
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Credential | MD
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Telephone | 973-322-4212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 25MA06058800
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License Number State | NJ
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