Provider Demographics
NPI:1952592214
Name:TRINITAS RADIATION ONCOLOGY ASSOC, PA
Entity Type:Organization
Organization Name:TRINITAS RADIATION ONCOLOGY ASSOC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RADIATION ONCOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:IVKER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:908-994-8393
Mailing Address - Street 1:PO BOX 659
Mailing Address - Street 2:
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-0659
Mailing Address - Country:US
Mailing Address - Phone:973-322-4212
Mailing Address - Fax:973-322-4132
Practice Address - Street 1:225 WILLIAMSON ST
Practice Address - Street 2:RADIATION ONCOLOGY DEPT.
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07202-3625
Practice Address - Country:US
Practice Address - Phone:908-994-8393
Practice Address - Fax:908-994-8725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-01
Last Update Date:2007-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB061933002085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6676308Medicaid
NJ796951Medicare PIN
NJG01691Medicare UPIN