Provider Demographics
NPI:1518232586
Name:REGIONAL CANCER CARE ASSOCIATES LLC
Entity Type:Organization
Organization Name:REGIONAL CANCER CARE ASSOCIATES LLC
Other - Org Name:NORTHERN NEW JERSEY CANCER ASSOCIATES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:TERRILL
Authorized Official - Middle Name:
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-510-0910
Mailing Address - Street 1:25 MAIN ST STE 502
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-7082
Mailing Address - Country:US
Mailing Address - Phone:201-510-0910
Mailing Address - Fax:201-880-8774
Practice Address - Street 1:210 S SHORE RD
Practice Address - Street 2:SUITE 106
Practice Address - City:MARMORA
Practice Address - State:NJ
Practice Address - Zip Code:08223-1200
Practice Address - Country:US
Practice Address - Phone:609-390-7888
Practice Address - Fax:609-390-2614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-09
Last Update Date:2024-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6682390005Medicare NSC