Provider Demographics
NPI:1215201298
Name:REGIONAL CANCER CARE ASSOCIATES
Entity Type:Organization
Organization Name:REGIONAL CANCER CARE ASSOCIATES
Other - Org Name:NORTHERN NEW JERSEY CANCER ASSOCIATES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:T
Authorized Official - Last Name:DEROSA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:973-538-5210
Mailing Address - Street 1:100 MADISON AVE
Mailing Address - Street 2:CAROL G. SIMON CANCER CENTER, 2ND FLOOR
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-6136
Mailing Address - Country:US
Mailing Address - Phone:973-538-5210
Mailing Address - Fax:973-644-9657
Practice Address - Street 1:100 MADISON AVE
Practice Address - Street 2:CAROL G. SIMON CANCER CENTER, 2ND FLOOR
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-6136
Practice Address - Country:US
Practice Address - Phone:973-538-5210
Practice Address - Fax:973-644-9657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-08
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6682390004Medicare NSC