1578698601 NPI number — EAST COAST RADIATION ONCOLOGY ASSOCIATES NEWARK BETH ISRAEL, PA

Table of content: (NPI 1578698601)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578698601 NPI number — EAST COAST RADIATION ONCOLOGY ASSOCIATES NEWARK BETH ISRAEL, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EAST COAST RADIATION ONCOLOGY ASSOCIATES NEWARK BETH ISRAEL, PA
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:
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NPI Number Information

NPI Number:
1578698601
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/29/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 LYONS AVE
Provider Second Line Business Mailing Address:
DEPT OF RADIATION ONCOLOGY - E2
Provider Business Mailing Address City Name:
NEWARK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07112-2027
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-322-4212
Provider Business Mailing Address Fax Number:
973-322-4132

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 LYONS AVE
Provider Second Line Business Practice Location Address:
DEPT OF RADIATION ONCOLOGY - E2
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07112-2027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-322-4212
Provider Business Practice Location Address Fax Number:
973-322-4132
Provider Enumeration Date:
02/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
IVKER
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
A
Authorized Official Title or Position:
RADIATION ONCOLOGIST
Authorized Official Telephone Number:
973-926-7320

Provider Taxonomy Codes

  • Taxonomy code: 2085R0001X , with the licence number:  25MB06193300 , 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: 7739001 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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