Basic Information
| Provider Information | |||||||||
| NPI: | 1558503797 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNIVERSITY PHYSICIAN ASSOCIATES OF NEW JERSEY, INC. | ||||||||
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| OtherOrganizationName: | UNIVERSITY RADIATION/ONCOLOGY ASSOCIATES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 30 BERGEN STREET | ||||||||
| Address2: | ADMC 12 1205 | ||||||||
| City: | NEWARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 071073000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9739720037 | ||||||||
| FaxNumber: | 9739720743 | ||||||||
| Practice Location | |||||||||
| Address1: | 205 S ORANGE AVE | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 071032785 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9739725053 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2009 | ||||||||
| LastUpdateDate: | 08/13/2019 | ||||||||
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| AuthorizedOfficialLastName: | HAIER | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO/EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9739729503 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | UNIVERSITY PHYSICIAN ASSOCIATES OF NEW JERSEY INC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
No ID Information.