Provider Demographics
NPI:1679502488
Name:ACADEMIC RADIATION ONCOLOGY, PC
Entity Type:Organization
Organization Name:ACADEMIC RADIATION ONCOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:L
Authorized Official - Last Name:KORNMEHL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-365-5088
Mailing Address - Street 1:900 ROUTE 70 EAST
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5940
Mailing Address - Country:US
Mailing Address - Phone:732-901-7314
Mailing Address - Fax:732-901-5704
Practice Address - Street 1:900 ROUTE 70 EAST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5940
Practice Address - Country:US
Practice Address - Phone:732-901-7314
Practice Address - Fax:732-901-5704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ104002Medicare PIN