Provider Demographics
NPI:1114977402
Name:EAST JEFFERSON RADIATION ONCOLOGY, LLC
Entity Type:Organization
Organization Name:EAST JEFFERSON RADIATION ONCOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPARTMENT ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RICKY
Authorized Official - Middle Name:
Authorized Official - Last Name:STONICHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-454-1724
Mailing Address - Street 1:4204 HOUMA BLVD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2903
Mailing Address - Country:US
Mailing Address - Phone:504-454-1727
Mailing Address - Fax:504-455-4857
Practice Address - Street 1:4204 HOUMA BLVD
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2903
Practice Address - Country:US
Practice Address - Phone:504-454-1724
Practice Address - Fax:504-455-4857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty