Provider Demographics
NPI:1962696773
Name:CANCER SURGERY ASSOCIATES,LLC
Entity type:Organization
Organization Name:CANCER SURGERY ASSOCIATES,LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCCAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-342-1010
Mailing Address - Street 1:20 PROSPECT AVE
Mailing Address - Street 2:SUITE 603
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-1997
Mailing Address - Country:US
Mailing Address - Phone:201-342-1010
Mailing Address - Fax:201-342-1030
Practice Address - Street 1:20 PROSPECT AVE
Practice Address - Street 2:SUITE 603
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1997
Practice Address - Country:US
Practice Address - Phone:201-342-1010
Practice Address - Fax:201-342-1030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-05
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA67928302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7840705Medicaid
NJ116324Medicare PIN
NJG78910Medicare UPIN