Basic Information
| Provider Information | |||||||||
| NPI: | 1467492736 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PRECISION RADIATION ONCOLOGY PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1020A E BOAL AVE | ||||||||
| Address2: | |||||||||
| City: | BOALSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 168271509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8142378627 | ||||||||
| FaxNumber: | 8142380083 | ||||||||
| Practice Location | |||||||||
| Address1: | JIMMIE LEEDS RD | ||||||||
| Address2: | |||||||||
| City: | POMONO | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6096523417 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | DALZELL | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6096523417 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | NJ | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 2134363000 | 01 | NJ | AMERIHEALTH | OTHER | 8901009 | 05 | NJ | MEDICAID | 2937437 | 01 | NJ | USHC | OTHER |