Provider Demographics
NPI:1013044585
Name:JERSEY SHORE BRACHYTHERAPY P A
Entity Type:Organization
Organization Name:JERSEY SHORE BRACHYTHERAPY P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEWART
Authorized Official - Middle Name:A
Authorized Official - Last Name:BERKOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-739-6476
Mailing Address - Street 1:6 REGAL CT
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-5642
Mailing Address - Country:US
Mailing Address - Phone:732-739-6476
Mailing Address - Fax:732-739-2056
Practice Address - Street 1:900 ROUTE 70 WEST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5940
Practice Address - Country:US
Practice Address - Phone:732-739-6476
Practice Address - Fax:732-739-2056
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JERSEY SHORE BRACHYTHERAPY PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-28
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
598919Medicare ID - Type Unspecified