Provider Demographics
NPI:1972776672
Name:HEMATOLOGY-ONCOLOGY ASSOCIATES OF NORTH JERSEY LLC
Entity type:Organization
Organization Name:HEMATOLOGY-ONCOLOGY ASSOCIATES OF NORTH JERSEY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:HAMDY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MOHTASEB
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACP
Authorized Official - Phone:928-219-4560
Mailing Address - Street 1:3003 HIGHWAY 95 STE G73
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-7860
Mailing Address - Country:US
Mailing Address - Phone:928-219-4560
Mailing Address - Fax:928-219-4561
Practice Address - Street 1:3003 HIGHWAY 95 STE G73
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-7860
Practice Address - Country:US
Practice Address - Phone:928-219-4560
Practice Address - Fax:928-219-4561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207RH0003X
AZ6441700001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6670901Medicaid
044000OtherMEDICARE ID TYPE UNSPECIF
NJMA61425OtherNJ LICENSE
NJMA61425OtherNJ LICENSE
NJ6670901Medicaid