Provider Demographics
NPI:1316371453
Name:MEADOWLANDS CANCER CENTER, LLC
Entity Type:Organization
Organization Name:MEADOWLANDS CANCER CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:EANELLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-695-5999
Mailing Address - Street 1:2 LAKE ST
Mailing Address - Street 2:C/O TURBO DOG CLAIMS
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-3542
Mailing Address - Country:US
Mailing Address - Phone:845-837-1388
Mailing Address - Fax:845-837-1389
Practice Address - Street 1:55 MEADOWLANDS PKWY
Practice Address - Street 2:
Practice Address - City:SECAUCUS
Practice Address - State:NJ
Practice Address - Zip Code:07094-2977
Practice Address - Country:US
Practice Address - Phone:845-837-1388
Practice Address - Fax:845-837-1389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-26
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology
No261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, Radiation