Provider Demographics
NPI:1053441071
Name:IYENGAR HEMATOLOGY ONCOLOGY MEDICAL CENTER PA
Entity Type:Organization
Organization Name:IYENGAR HEMATOLOGY ONCOLOGY MEDICAL CENTER PA
Other - Org Name:HUDSON HEMATOLOGY ONCOLOGY ASSOCIATES PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:REKHA
Authorized Official - Middle Name:D
Authorized Official - Last Name:IYENGAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-858-1211
Mailing Address - Street 1:PO BOX 1579
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-7179
Mailing Address - Country:US
Mailing Address - Phone:201-858-1211
Mailing Address - Fax:201-858-4171
Practice Address - Street 1:27 E 29TH ST
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-4654
Practice Address - Country:US
Practice Address - Phone:201-858-1211
Practice Address - Fax:201-858-4171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ726436Medicare ID - Type Unspecified