Provider Demographics
NPI:1265693022
Name:REGIONAL RADIATION ONCOLOGY PA
Entity type:Organization
Organization Name:REGIONAL RADIATION ONCOLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF GROUP
Authorized Official - Prefix:
Authorized Official - First Name:JO ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHALAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-599-5169
Mailing Address - Street 1:3625 QUAKERBRIDGE ROAD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08619
Mailing Address - Country:US
Mailing Address - Phone:609-689-1600
Mailing Address - Fax:609-689-1200
Practice Address - Street 1:601 HAMILTON AVE
Practice Address - Street 2:ST FRANCIS MEDICAL CENTER
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08629
Practice Address - Country:US
Practice Address - Phone:609-599-5179
Practice Address - Fax:609-599-6219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ11887632085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0102776Medicaid
NJ097832Medicare PIN