Provider Demographics
NPI:1104814060
Name:CABRERA, ROY C (MD)
Entity type:Individual
Prefix:DR
First Name:ROY
Middle Name:C
Last Name:CABRERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4127
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-0127
Mailing Address - Country:US
Mailing Address - Phone:908-754-7711
Mailing Address - Fax:908-754-8885
Practice Address - Street 1:33 OVERLOOK RD
Practice Address - Street 2:SUITE L-05
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-3570
Practice Address - Country:US
Practice Address - Phone:908-522-2871
Practice Address - Fax:908-522-5628
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA029760002085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1916408Medicaid
NJC63186Medicare UPIN
NJ403531ACHMedicare PIN