Provider Demographics
NPI:1144211087
Name:SOUTHERN ONCOLOGY HEMATOLOGY ASSOC
Entity Type:Organization
Organization Name:SOUTHERN ONCOLOGY HEMATOLOGY ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KUSH
Authorized Official - Middle Name:
Authorized Official - Last Name:SACHDEVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-696-9550
Mailing Address - Street 1:1505 W. SHERMAN AVENUE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-5838
Mailing Address - Country:US
Mailing Address - Phone:856-696-9550
Mailing Address - Fax:856-696-4932
Practice Address - Street 1:1505 W SHERMAN AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-6912
Practice Address - Country:US
Practice Address - Phone:856-696-9550
Practice Address - Fax:856-696-4932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-31
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0090340000OtherKEYSTONE
181780OtherMEDICARE
NJ90000556000OtherAMERICHOICE
NJ1028961OtherMERCY HEALTH PLAN
NJ83520001OtherTRAVELERS
NJ34836OtherUS HEALTHCARE
NJ0090340000OtherAMERIHEALTH
NJ25877503Medicaid
NJ873520001OtherHEALTHNOW
NJ34836OtherUS HEALTHCARE
NJ90000556000OtherAMERICHOICE
NJ=========OtherFIRST HEALTH
NJ=========OtherAETNA MANAGED CHOICE
NJ1028961OtherMERCY HEALTH PLAN