Provider Demographics
NPI:1598744922
Name:PROFESSIONAL RADIATION ONCOLOGY SERVICES
Entity Type:Organization
Organization Name:PROFESSIONAL RADIATION ONCOLOGY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOROWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-582-3008
Mailing Address - Street 1:1020A E BOAL AVE
Mailing Address - Street 2:
Mailing Address - City:BOALSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16827-1509
Mailing Address - Country:US
Mailing Address - Phone:814-237-8627
Mailing Address - Fax:814-238-0083
Practice Address - Street 1:900 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-2358
Practice Address - Country:US
Practice Address - Phone:856-582-3008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG2531963OtherOXFORD HEALTH
NJ0026816Medicaid
NJ1352192OtherAMERIHEALTH PPO
NJ2044646000OtherKEYSTONE HEALTH PLAN EAST
NJW086OtherAMERIGROUP
NJG2531963OtherOXFORD HEALTH
NJCJ5410Medicare ID - Type UnspecifiedRAILROAD MEDICARE