Provider Demographics
NPI:1104972678
Name:NEW JERSEY UROLOGY ASSOCIATES,P.A.
Entity type:Organization
Organization Name:NEW JERSEY UROLOGY ASSOCIATES,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-C.E.O.
Authorized Official - Prefix:
Authorized Official - First Name:IRA
Authorized Official - Middle Name:D
Authorized Official - Last Name:TANZER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-788-2437
Mailing Address - Street 1:PO BOX 250
Mailing Address - Street 2:
Mailing Address - City:SADDLE RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07458-0250
Mailing Address - Country:US
Mailing Address - Phone:201-962-3919
Mailing Address - Fax:201-962-3698
Practice Address - Street 1:110 MEADOWLANDS PKWY # B
Practice Address - Street 2:SUITE 302
Practice Address - City:SECAUCUS
Practice Address - State:NJ
Practice Address - Zip Code:07094-2302
Practice Address - Country:US
Practice Address - Phone:201-867-1297
Practice Address - Fax:201-867-4165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA030534174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ527328Medicare PIN