1154400984 NPI number — THE CANCER CENTER PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154400984 NPI number — THE CANCER CENTER PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE CANCER CENTER PC
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:
6
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:
1154400984
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/04/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22 NORMANDY PARKWAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORRISTOWN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07960
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-232-1104
Provider Business Mailing Address Fax Number:
973-984-6661

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
66 SUNSET STRIP STE 309
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUCCASUNNA
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07876-1362
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-232-1104
Provider Business Practice Location Address Fax Number:
973-984-6661
Provider Enumeration Date:
11/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
COLE
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
JOHN
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
973-951-1225

Provider Taxonomy Codes

  • Taxonomy code: 2085R0203X , with the licence number:  MA42604 , 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: 5295771871 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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