Provider Demographics
NPI: | 1003249087 |
---|---|
Name: | ATLANTIC ONCOLOGY ASSOCIATES, LLC |
Entity Type: | Organization |
Organization Name: | ATLANTIC ONCOLOGY ASSOCIATES, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | MEMBER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | NASSER |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | BORAI |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 609-404-9966 |
Mailing Address - Street 1: | 54 W JIMMIE LEEDS RD |
Mailing Address - Street 2: | SUITE 11 |
Mailing Address - City: | GALLOWAY |
Mailing Address - State: | NJ |
Mailing Address - Zip Code: | 08205-9438 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 609-404-9966 |
Mailing Address - Fax: | 609-404-9967 |
Practice Address - Street 1: | 54 W JIMMIE LEEDS RD |
Practice Address - Street 2: | SUITE 11 |
Practice Address - City: | GALLOWAY |
Practice Address - State: | NJ |
Practice Address - Zip Code: | 08205-9438 |
Practice Address - Country: | US |
Practice Address - Phone: | 609-404-9966 |
Practice Address - Fax: | 609-404-9967 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2013-08-14 |
Last Update Date: | 2013-08-14 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207RH0003X | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | Group - Single Specialty |