Provider Demographics
NPI:1639155211
Name:SOUTHERN OCEAN CO RADIATION ONCOLOGY
Entity Type:Organization
Organization Name:SOUTHERN OCEAN CO RADIATION ONCOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:R
Authorized Official - Last Name:COIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-978-2194
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 1:1140 ROUTE 72 W
Practice Address - Street 2:
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-2412
Practice Address - Country:US
Practice Address - Phone:609-978-2194
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-16
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
NJ160062FEOtherPREFERRED CARE
NJ0446192000OtherAMERIHEALTH HMO/POS
NJ1138272VOtherHORIZON NJ HEALTH
NJ2351436OtherAETNA HMO
NJ424534OtherAMERIHEALTH PPO
NJ8332703Medicaid
NJ160062FEOtherPREFERRED CARE
NJ424534OtherAMERIHEALTH PPO
NJ=========OtherOXFORD
NJ=========OtherAETNA PPO
NJ=========OtherHEALTHNET
NJ=========OtherUNIVERSITY HEALTH PLAN
NJCHO676Medicare ID - Type UnspecifiedRAILROAD MEDICARE