Provider Demographics
NPI:1972807824
Name:HACKENSACK RADIATION THERAPY LLC
Entity Type:Organization
Organization Name:HACKENSACK RADIATION THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:VARDARO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-880-7580
Mailing Address - Street 1:20 WOODRIDGE AVENUE
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-6013
Mailing Address - Country:US
Mailing Address - Phone:201-880-7580
Mailing Address - Fax:201-880-7585
Practice Address - Street 1:20 WOODRIDGE AVE
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-6013
Practice Address - Country:US
Practice Address - Phone:201-880-7580
Practice Address - Fax:201-880-7585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-07
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ04003209832085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0256277Medicaid