MEDICARE: HOPE COMMUNITY CANCER CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0003X	Hematology & Oncology Physician

General Provider Information

NPI Number	:	1114914694
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOPE COMMUNITY CANCER CENTER, LLC

Provider Business Mailing Address
First Line	:	210 S. SHORE RD.
Second Line	:	STE 102-106
City	:	MARMORA
State	:	NJ
Zip	:	08223-1271
Country	:	US
Telephone Number	:	609-390-7888
Fax Number	:	609-390-2614

Provider Business Practice Location Address
First Line	:	210 S. SHORE RD.
Second Line	:	STE 102-106
City	:	MARMORA
State	:	NJ
Zip	:	08223-1271
Country	:	US
Telephone Number	:	609-390-7888
Fax Number	:	609-390-2614

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	RICHARD VERNOUSKI
Credential	:
Telephone Number	:	609-390-7888

Provider Enumeration Date	:	09/30/2005
Last Update Date	:	02/25/2011

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