Basic Information
| Provider Information | |||||||||
| NPI: | 1982858502 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CYBER RADIATION ONCOLOGY SRS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7905 BAYSHORE DR | ||||||||
| Address2: | |||||||||
| City: | MARGATE CITY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 084021805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6096523417 | ||||||||
| FaxNumber: | 6094870437 | ||||||||
| Practice Location | |||||||||
| Address1: | JIMMIE LEEDS RD | ||||||||
| Address2: | |||||||||
| City: | POMONA | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082409100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6096523417 | ||||||||
| FaxNumber: | 6094870437 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/10/2008 | ||||||||
| LastUpdateDate: | 01/13/2011 | ||||||||
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| AuthorizedOfficialLastName: | CASSIR | ||||||||
| AuthorizedOfficialFirstName: | JORGE | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 6096523417 | ||||||||
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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 | 1420614 | NJ | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
No ID Information.