Provider Demographics
NPI:1093018202
Name:CENTRAL JERSEY ONCOLOGY CENTER, PA
Entity Type:Organization
Organization Name:CENTRAL JERSEY ONCOLOGY CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:BRUNO
Authorized Official - Middle Name:S
Authorized Official - Last Name:FANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-828-9570
Mailing Address - Street 1:J2 BRIER HILL CT
Mailing Address - Street 2:
Mailing Address - City:E. BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816
Mailing Address - Country:US
Mailing Address - Phone:732-390-7750
Mailing Address - Fax:732-390-7725
Practice Address - Street 1:300A PRINCETON HIGHTSTOWN RD
Practice Address - Street 2:SUITE 202
Practice Address - City:EAST WINDSOR
Practice Address - State:NJ
Practice Address - Zip Code:08520-1421
Practice Address - Country:US
Practice Address - Phone:732-390-7750
Practice Address - Fax:732-390-7725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-09
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03514200207RH0003X
NJ25MA04923400207RH0003X
NJ25MA04468600207RH0003X
NJ25MA07087400207RH0003X
NJ25MA07142100207RH0003X
NJ25MA07301300207RH0003X
NJ25MA08099000207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJI39716Medicare UPIN
NJH23304Medicare UPIN
NJI63926Medicare UPIN
H28443Medicare UPIN
NJB69656Medicare UPIN
NJB76533Medicare UPIN
NJD06914Medicare UPIN