Provider Demographics
NPI:1154178929
Name:REGIONAL CANCER CARE ASSOCIATES LLC
Entity type:Organization
Organization Name:REGIONAL CANCER CARE ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TERRILL
Authorized Official - Middle Name:
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-510-0910
Mailing Address - Street 1:500 FRANK W BURR BLVD STE 560
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-6804
Mailing Address - Country:US
Mailing Address - Phone:201-510-0910
Mailing Address - Fax:
Practice Address - Street 1:15 MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-3447
Practice Address - Country:US
Practice Address - Phone:908-755-1165
Practice Address - Fax:908-755-2093
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REGIONAL CANCER CARE ASSOCIATES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty