Provider Demographics
NPI:1649225525
Name:COLFAX ONCOLOGY LLC
Entity Type:Organization
Organization Name:COLFAX ONCOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARDS
Authorized Official - Middle Name:
Authorized Official - Last Name:AFONJA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-594-7977
Mailing Address - Street 1:PO BOX 857
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07015-0857
Mailing Address - Country:US
Mailing Address - Phone:973-594-7977
Mailing Address - Fax:
Practice Address - Street 1:476 COLFAX AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-1624
Practice Address - Country:US
Practice Address - Phone:973-594-7977
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA61127174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6763901Medicaid
NJ123020Medicare PIN
NJG19659Medicare UPIN