Provider Demographics
NPI:1124257753
Name:HEMATOLOGY-ONCOLOGY PROFESSIONAL OF WAYNE
Entity type:Organization
Organization Name:HEMATOLOGY-ONCOLOGY PROFESSIONAL OF WAYNE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PEYMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGHSOUDLOU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-773-2039
Mailing Address - Street 1:PO BOX 4237
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07012-4237
Mailing Address - Country:US
Mailing Address - Phone:973-773-2039
Mailing Address - Fax:
Practice Address - Street 1:8028 BRITTANY DR
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-3297
Practice Address - Country:US
Practice Address - Phone:973-773-2039
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-02
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematologyGroup - Multi-Specialty