Provider Demographics
NPI:1134565997
Name:REGIONAL CANCER CARE ASSOCIATES AT THE JOHN THEURER CANCER CENTER
Entity type:Organization
Organization Name:REGIONAL CANCER CARE ASSOCIATES AT THE JOHN THEURER CANCER CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:551-996-5900
Mailing Address - Street 1:112 CADMUS AVE
Mailing Address - Street 2:
Mailing Address - City:ELMWOOD PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07407-2500
Mailing Address - Country:US
Mailing Address - Phone:201-314-3665
Mailing Address - Fax:
Practice Address - Street 1:92 2ND ST
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-2105
Practice Address - Country:US
Practice Address - Phone:551-996-5900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-20
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00435700363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty