1104972678 NPI number — NEW JERSEY UROLOGY ASSOCIATES,P.A.

Table of content: (NPI 1104972678)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104972678 NPI number — NEW JERSEY UROLOGY ASSOCIATES,P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW JERSEY UROLOGY ASSOCIATES,P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104972678
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 250
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SADDLE RIVER
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07458-0250
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-962-3919
Provider Business Mailing Address Fax Number:
201-962-3698

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 MEADOWLANDS PKWY # B
Provider Second Line Business Practice Location Address:
SUITE 302
Provider Business Practice Location Address City Name:
SECAUCUS
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07094-2302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-867-1297
Provider Business Practice Location Address Fax Number:
201-867-4165
Provider Enumeration Date:
01/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TANZER
Authorized Official First Name:
IRA
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PRESIDENT-C.E.O.
Authorized Official Telephone Number:
201-788-2437

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  MA030534 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com