Provider Demographics
NPI:1902858020
Name:BAYONNE RADIATION ONCOLOGY ASSOCIATES, LLC
Entity Type:Organization
Organization Name:BAYONNE RADIATION ONCOLOGY ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WESSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-684-1616
Mailing Address - Street 1:27 E 29TH ST
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-4654
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 LETHBRIDGE PLZ
Practice Address - Street 2:ROUTE 17 NORTH, SUITE #20
Practice Address - City:MAHWAH
Practice Address - State:NJ
Practice Address - Zip Code:07430-2126
Practice Address - Country:US
Practice Address - Phone:201-684-1616
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ094555Medicare ID - Type UnspecifiedBROA GROUP MEDICARE #