Provider Demographics
NPI:1902104573
Name:JERSEY CITY RADIATION THERAPY LLC
Entity Type:Organization
Organization Name:JERSEY CITY RADIATION THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:VARDARO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-791-4544
Mailing Address - Street 1:631 GRAND STREET
Mailing Address - Street 2:SUITE 1-1
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07304
Mailing Address - Country:US
Mailing Address - Phone:201-791-4544
Mailing Address - Fax:201-794-6970
Practice Address - Street 1:631 GRAND STREET
Practice Address - Street 2:SUITE 1-1
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07304
Practice Address - Country:US
Practice Address - Phone:201-791-4544
Practice Address - Fax:201-794-6970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-07
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ04003295892085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty