1285679654 NPI number — UROLOGICAL ASSOCIATES OF LI, PC

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 1285679654 NPI number — UROLOGICAL ASSOCIATES OF LI, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UROLOGICAL ASSOCIATES OF LI, PC
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:
1285679654
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
250 YAPHANK RD
Provider Second Line Business Mailing Address:
STE 11B
Provider Business Mailing Address City Name:
EAST PATCHOGUE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11772-4800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-475-5051
Provider Business Mailing Address Fax Number:
631-475-8268

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
250 YAPHANK RD
Provider Second Line Business Practice Location Address:
STE 11B
Provider Business Practice Location Address City Name:
EAST PATCHOGUE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11772-4800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-475-5051
Provider Business Practice Location Address Fax Number:
631-475-8268
Provider Enumeration Date:
06/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MARKIN
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
631-475-5051

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: C14556 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com