Provider Demographics
NPI:1447315502
Name:REGIONAL CANCER CARE ASSOCIATES LLC
Entity type:Organization
Organization Name:REGIONAL CANCER CARE ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:TERRILL
Authorized Official - Middle Name:
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-510-0910
Mailing Address - Street 1:500 FRANK W BURR BLVD STE 560
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-6804
Mailing Address - Country:US
Mailing Address - Phone:973-751-8880
Mailing Address - Fax:973-751-8950
Practice Address - Street 1:1 CLARA MAASS DR STE 200
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-3550
Practice Address - Country:US
Practice Address - Phone:973-751-8880
Practice Address - Fax:973-751-8950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1078832OtherHORIZON NJ HEALTH
NJ831711OtherUNITED HEALTHCARE
NJAMERIHEALTH PPOOther880459
NJCI9695OtherRAILROAD MEDICARE
NJAETNA TRADITIONALOther8750231
NJW5L541OtherEMPIREWELLCHOICE
NJ3036308Medicaid
NJ2138244OtherAETNA HMO
NJAMERIHEALTH HMOOther993839000
NJ3036308Medicaid
NJAMERIHEALTH HMOOther993839000