Basic Information
| Provider Information | |||||||||
| NPI: | 1265693022 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | REGIONAL RADIATION ONCOLOGY PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3625 QUAKERBRIDGE ROAD | ||||||||
| Address2: | |||||||||
| City: | HAMILTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6096891600 | ||||||||
| FaxNumber: | 6096891200 | ||||||||
| Practice Location | |||||||||
| Address1: | 601 HAMILTON AVE | ||||||||
| Address2: | ST FRANCIS MEDICAL CENTER | ||||||||
| City: | TRENTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08629 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6095995179 | ||||||||
| FaxNumber: | 6095996219 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2008 | ||||||||
| LastUpdateDate: | 06/24/2008 | ||||||||
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| AuthorizedOfficialLastName: | CHALAL | ||||||||
| AuthorizedOfficialFirstName: | JO ANN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT OF GROUP | ||||||||
| AuthorizedOfficialTelephone: | 6095995169 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | 1188763 | NJ | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 0102776 | 05 | NJ | MEDICAID |