Provider Demographics
NPI:1154403418
Name:UROLOGIC SPECIALTIES PA
Entity type:Organization
Organization Name:UROLOGIC SPECIALTIES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:M
Authorized Official - Last Name:RASMUSSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-569-7777
Mailing Address - Street 1:177 NORTH DEAN ST
Mailing Address - Street 2:SUITE 305
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631
Mailing Address - Country:US
Mailing Address - Phone:201-569-7777
Mailing Address - Fax:201-569-6861
Practice Address - Street 1:177 NORTH DEAN ST
Practice Address - Street 2:SUITE 305
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631
Practice Address - Country:US
Practice Address - Phone:201-569-7777
Practice Address - Fax:201-569-6861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ526418Medicare ID - Type Unspecified