Provider Demographics
NPI:1881990596
Name:COMMUNITY CANCER CARE OF BAYONNE
Entity type:Organization
Organization Name:COMMUNITY CANCER CARE OF BAYONNE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:EVELYNDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-443-4080
Mailing Address - Street 1:PO BOX 3395
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-0287
Mailing Address - Country:US
Mailing Address - Phone:201-443-4080
Mailing Address - Fax:
Practice Address - Street 1:564 BROADWAY
Practice Address - Street 2:SUITE 102
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-8828
Practice Address - Country:US
Practice Address - Phone:201-443-4080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-28
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02830300174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty