Provider Demographics
NPI:1235236423
Name:HEMATOLOGY ASSOC OF NJ PA
Entity Type:Organization
Organization Name:HEMATOLOGY ASSOC OF NJ PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:R
Authorized Official - Last Name:FERNBACH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-634-5353
Mailing Address - Street 1:1 VALLEY HEALTH PLZ
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-3628
Mailing Address - Country:US
Mailing Address - Phone:201-634-5353
Mailing Address - Fax:
Practice Address - Street 1:1 VALLEY HEALTH PLZ
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-3628
Practice Address - Country:US
Practice Address - Phone:201-634-5353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2816709Medicaid
NJCB4007OtherRAILROAD MEDICARE
NJ2816709Medicaid