1134290752 NPI number — UNIVERSITY UROLOGY ASSOCIATES, PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134290752 NPI number — UNIVERSITY UROLOGY ASSOCIATES, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY UROLOGY ASSOCIATES, PA
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:
1134290752
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 PROSPECT AVE
Provider Second Line Business Mailing Address:
SUITE 719
Provider Business Mailing Address City Name:
HACKENSACK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07601-1997
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-343-0082
Provider Business Mailing Address Fax Number:
201-488-1203

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
630 BROAD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARLSTADT
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07072-1114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-460-8600
Provider Business Practice Location Address Fax Number:
201-460-8603
Provider Enumeration Date:
11/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROSENBERG
Authorized Official First Name:
GENE
Authorized Official Middle Name:
Authorized Official Title or Position:
DELEGATED OFFICIAL
Authorized Official Telephone Number:
201-343-0082

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  25MA03648000 , 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)





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