Provider Demographics
NPI:1932527181
Name:REGIONAL CANCER CARE ASSOCIATES LLC
Entity type:Organization
Organization Name:REGIONAL CANCER CARE ASSOCIATES LLC
Other - Org Name:<UNAVAIL>
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 1:210 S SHORE RD
Mailing Address - Street 2:STE 106
Mailing Address - City:MARMORA
Mailing Address - State:NJ
Mailing Address - Zip Code:08223-1200
Mailing Address - Country:US
Mailing Address - Phone:609-390-7888
Mailing Address - Fax:609-390-2614
Practice Address - Street 1:211 N MAIN ST
Practice Address - Street 2:STE 100
Practice Address - City:CAPE MAY COURT HOUSE
Practice Address - State:NJ
Practice Address - Zip Code:08210-2163
Practice Address - Country:US
Practice Address - Phone:609-536-8414
Practice Address - Fax:609-536-8412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-04
Last Update Date:2024-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA062569174400000X
NJ25MB052916174400000X
NJ25MA059378174400000X
NJ25MA088212174400000X
207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG53110Medicare UPIN
NJF36925Medicare UPIN
NJG66877Medicare UPIN
NJ197031P24Medicare PIN