Provider Demographics
NPI:1235260704
Name:WAYNE HEMATOLOGY ONCOLOGY ASSOCIATES P C
Entity Type:Organization
Organization Name:WAYNE HEMATOLOGY ONCOLOGY ASSOCIATES P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VIJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-694-5005
Mailing Address - Street 1:468 PARISH DR STE 4
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-4671
Mailing Address - Country:US
Mailing Address - Phone:973-694-5005
Mailing Address - Fax:973-694-5990
Practice Address - Street 1:468 PARISH DR STE 4
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-4671
Practice Address - Country:US
Practice Address - Phone:973-694-5005
Practice Address - Fax:973-694-5990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6798403Medicaid
NJ6798403Medicaid