Provider Demographics
NPI:1114954526
Name:ADULT MEDICAL ONCOLOGY HEMATOLOGY GROUP LLC
Entity Type:Organization
Organization Name:ADULT MEDICAL ONCOLOGY HEMATOLOGY GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-576-8610
Mailing Address - Street 1:39 SYCAMORE AVE
Mailing Address - Street 2:
Mailing Address - City:LITTLE SILVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07739
Mailing Address - Country:US
Mailing Address - Phone:732-576-8610
Mailing Address - Fax:732-576-8823
Practice Address - Street 1:39 SYCAMORE AVE
Practice Address - Street 2:
Practice Address - City:LITTLE SILVER
Practice Address - State:NJ
Practice Address - Zip Code:07739
Practice Address - Country:US
Practice Address - Phone:732-576-8610
Practice Address - Fax:732-576-8823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04275800207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ055912Medicare ID - Type Unspecified
4196370001Medicare NSC