Provider Demographics
NPI:1831234954
Name:THE MINNITI CENTER FOR MEDICAL ONCOLOGY AND HEMATOLOGY
Entity type:Organization
Organization Name:THE MINNITI CENTER FOR MEDICAL ONCOLOGY AND HEMATOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARL
Authorized Official - Middle Name:J
Authorized Official - Last Name:MINNITI
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:856-423-0754
Mailing Address - Street 1:174 DEMOCRAT RD
Mailing Address - Street 2:
Mailing Address - City:MICKLETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08056-1236
Mailing Address - Country:US
Mailing Address - Phone:856-423-0754
Mailing Address - Fax:856-423-7508
Practice Address - Street 1:174 DEMOCRAT RD
Practice Address - Street 2:
Practice Address - City:MICKLETON
Practice Address - State:NJ
Practice Address - Zip Code:08056-1236
Practice Address - Country:US
Practice Address - Phone:856-423-0754
Practice Address - Fax:856-423-7508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA51205207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJF93754Medicare UPIN