Provider Demographics
NPI:1255529244
Name:ADVANCED CANCER CARE OF NEW JERSEY,PC
Entity type:Organization
Organization Name:ADVANCED CANCER CARE OF NEW JERSEY,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CHIRAG
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-244-3380
Mailing Address - Street 1:40 BEY LEA RD
Mailing Address - Street 2:SUITE B 102
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-2900
Mailing Address - Country:US
Mailing Address - Phone:732-244-3380
Mailing Address - Fax:732-244-9013
Practice Address - Street 1:40 BEY LEA RD
Practice Address - Street 2:SUITE B 102
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-2900
Practice Address - Country:US
Practice Address - Phone:732-244-3380
Practice Address - Fax:732-244-9013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2017-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05380300207RH0003X
NJ25MA06728200207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ092024Medicare PIN