1306091897 NPI number — UROLOGIC SPECIALISTS OF NEW ENGLAND, LLC

Table of content: (NPI 1306091897)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306091897 NPI number — UROLOGIC SPECIALISTS OF NEW ENGLAND, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UROLOGIC SPECIALISTS OF NEW ENGLAND, LLC
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:
1306091897
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
207 QUAKER LN
Provider Second Line Business Mailing Address:
1ST FLOOR
Provider Business Mailing Address City Name:
WEST WARWICK
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02893-2179
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-828-7110
Provider Business Mailing Address Fax Number:
401-827-6367

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
191 SOCIAL ST
Provider Second Line Business Practice Location Address:
6TH FLOOR
Provider Business Practice Location Address City Name:
WOONSOCKET
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02895-3240
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-765-0628
Provider Business Practice Location Address Fax Number:
401-765-3038
Provider Enumeration Date:
11/25/2008

Additional Information

Authorized Official

Authorized Official Last Name:
CAMBIO
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
C
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
401-828-7110

Provider Taxonomy Codes

  • Taxonomy code: 208800000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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