Provider Demographics
NPI:1851420707
Name:ATLANTIC HEMATOLOGY ONCOLOGY GROUP
Entity Type:Organization
Organization Name:ATLANTIC HEMATOLOGY ONCOLOGY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MAL
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-652-6750
Mailing Address - Street 1:4 E JIMMIE LEEDS RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-4465
Mailing Address - Country:US
Mailing Address - Phone:609-652-6750
Mailing Address - Fax:609-652-2306
Practice Address - Street 1:4 E JIMMIE LEEDS RD
Practice Address - Street 2:SUITE 4
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-4465
Practice Address - Country:US
Practice Address - Phone:609-652-6750
Practice Address - Fax:609-652-2306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05242500207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ000428946OtherHIGHMARK
NJ5003495OtherCAPITAL BCBS
NJ0017190OtherAETNA
NJ1045671OtherHORIZON NJ HEALTH
NJ3403408Medicaid
NJP1969353OtherOXFORD
NJ=========OtherFIRST HEALTH
NJ=========OtherHORIZON
NJ3403408Medicaid
NJ=========OtherCIGNA
NJ=========OtherHEALTH NET
NJ0017190OtherAETNA
NJ=========OtherTRICARE FOR LIFE
NJ000428946OtherHIGHMARK
NJ=========OtherNALC
NJ=========OtherNJ CARPENTERS
NJP1969353OtherOXFORD
NJ3403408Medicaid