Provider Demographics
NPI:1972558344
Name:RADIATION ONCOLOGY ASSOC OF NORTH JERSEY PA
Entity Type:Organization
Organization Name:RADIATION ONCOLOGY ASSOC OF NORTH JERSEY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-971-6233
Mailing Address - Street 1:171 TECHNOLOGY DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BOALSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16827-1530
Mailing Address - Country:US
Mailing Address - Phone:814-237-8627
Mailing Address - Fax:814-238-0083
Practice Address - Street 1:100 MADISON AVE
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-6136
Practice Address - Country:US
Practice Address - Phone:973-971-6233
Practice Address - Fax:973-290-7393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7399405Medicaid
NJ471849OtherAMERIHEALTH
NJ0959903OtherAETNA USHC
NJ=========OtherOXFORD
NJ=========OtherCIGNA
NJ=========OtherGHI
NJ=========OtherMULTIPLAN
NJ7399405Medicaid
NJ=========OtherUNITED HEALTHCARE
NJ901436Medicare ID - Type Unspecified
NJ7399405Medicaid