MEDICARE: DR. CHARLES E SAGORIN M.D.

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	MA 35628	NJ

General Provider Information

NPI Number	:	1891796769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES E SAGORIN M.D.

Provider Business Mailing Address
First Line	:	70 PARK ST STE 310
Second Line	:
City	:	MONTCLAIR
State	:	NJ
Zip	:	07042-2960
Country	:	US
Telephone Number	:	973-783-3300
Fax Number	:	973-783-1168

Provider Business Practice Location Address
First Line	:	70 PARK ST STE 310
Second Line	:
City	:	MONTCLAIR
State	:	NJ
Zip	:	07042-2960
Country	:	US
Telephone Number	:	973-783-3300
Fax Number	:	973-783-1168

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	04/15/2021

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