Provider Demographics
NPI:1689622748
Name:MEDICAL ONCOLOGY ASSOCIATES AT SAINT BARNABAS
Entity Type:Organization
Organization Name:MEDICAL ONCOLOGY ASSOCIATES AT SAINT BARNABAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:AHEARN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-557-7119
Mailing Address - Street 1:PO BOX 18398
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07191-8398
Mailing Address - Country:US
Mailing Address - Phone:732-557-7119
Mailing Address - Fax:732-557-7109
Practice Address - Street 1:94 OLD SHORT HILLS RD
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-5672
Practice Address - Country:US
Practice Address - Phone:973-322-5658
Practice Address - Fax:973-322-8911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6692109Medicaid
NJ6692109Medicaid