1497700405 NPI number — ENGLEWOOD RADIATION ONCOLOGY, LLC

Table of content: (NPI 1497700405)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497700405 NPI number — ENGLEWOOD RADIATION ONCOLOGY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ENGLEWOOD RADIATION ONCOLOGY, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497700405
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
350 ENGLE ST
Provider Second Line Business Mailing Address:
LLO
Provider Business Mailing Address City Name:
ENGLEWOOD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07631-1808
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-894-3125
Provider Business Mailing Address Fax Number:
201-894-0152

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
350 ENGLE ST
Provider Second Line Business Practice Location Address:
LLO
Provider Business Practice Location Address City Name:
ENGLEWOOD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07631-1808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-894-3125
Provider Business Practice Location Address Fax Number:
201-894-0152
Provider Enumeration Date:
05/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DUBIN
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
201-894-3125

Provider Taxonomy Codes

  • Taxonomy code: 2085R0001X , with the licence number:  25MA05022800 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: BS525 . This is a "OXFORD DR. DUBIN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 5159300 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: P3226618 . This is a "OXFORD DR. ZHANG" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 7100293 . This is a "AETNA GROUP" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2737974 . This is a "AETNA DR. DUBIN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 7303563 . This is a "AETNA DR ZHANG" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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