Provider Demographics
NPI:1497700405
Name:ENGLEWOOD RADIATION ONCOLOGY, LLC
Entity Type:Organization
Organization Name:ENGLEWOOD RADIATION ONCOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:DUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-894-3125
Mailing Address - Street 1:350 ENGLE ST
Mailing Address - Street 2:LLO
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-1808
Mailing Address - Country:US
Mailing Address - Phone:201-894-3125
Mailing Address - Fax:201-894-0152
Practice Address - Street 1:350 ENGLE ST
Practice Address - Street 2:LLO
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-1808
Practice Address - Country:US
Practice Address - Phone:201-894-3125
Practice Address - Fax:201-894-0152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA050228002085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJBS525OtherOXFORD DR. DUBIN
NJ5159300Medicaid
NJP3226618OtherOXFORD DR. ZHANG
NJ7100293OtherAETNA GROUP
NJ2737974OtherAETNA DR. DUBIN
NJ7303563OtherAETNA DR ZHANG
NJP3226618OtherOXFORD DR. ZHANG
NJ7100293OtherAETNA GROUP
NJ5159300Medicaid