Provider Demographics
NPI:1568630903
Name:PROGRESSIVE RADIATION ONCOLOGY
Entity Type:Organization
Organization Name:PROGRESSIVE RADIATION ONCOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RADIATION ONCOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-322-4212
Mailing Address - Street 1:PO BOX 659
Mailing Address - Street 2:
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-0659
Mailing Address - Country:US
Mailing Address - Phone:973-322-4212
Mailing Address - Fax:973-322-4132
Practice Address - Street 1:30 REHILL AVE
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876-2500
Practice Address - Country:US
Practice Address - Phone:973-322-4212
Practice Address - Fax:973-322-4132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA060588002085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6199003Medicaid
NJ1407852726OtherNPI, INDIVIDUAL
NJ6199003Medicaid