Provider Demographics
NPI:1720454564
Name:COMMUNITY CANCER CENTERS OF AMERICA LLC
Entity Type:Organization
Organization Name:COMMUNITY CANCER CENTERS OF AMERICA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:PANKAJ
Authorized Official - Middle Name:K
Authorized Official - Last Name:AKSHAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-215-5535
Mailing Address - Street 1:691 STATE HIGHWAY 33
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08619
Mailing Address - Country:US
Mailing Address - Phone:201-215-5535
Mailing Address - Fax:844-241-7242
Practice Address - Street 1:691 STATE HIGHWAY 33
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08619
Practice Address - Country:US
Practice Address - Phone:201-215-5535
Practice Address - Fax:844-241-7242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-17
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA38585207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ726436Medicare PIN