Provider Demographics
NPI:1952303927
Name:RADIATION ONCOLOGY GROUP, P.A.
Entity Type:Organization
Organization Name:RADIATION ONCOLOGY GROUP, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:J
Authorized Official - Last Name:SPUNBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-964-2662
Mailing Address - Street 1:4685 S CONGRESS AVE
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33461-4710
Mailing Address - Country:US
Mailing Address - Phone:561-964-2662
Mailing Address - Fax:561-548-1635
Practice Address - Street 1:4685 S CONGRESS AVE
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461-4710
Practice Address - Country:US
Practice Address - Phone:561-964-2662
Practice Address - Fax:561-548-1635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-10
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL371397100Medicaid
FL97378Medicare ID - Type Unspecified