Provider Demographics
NPI:1154742096
Name:UROLOGIC SERVICES PLLC
Entity type:Organization
Organization Name:UROLOGIC SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SHUSTERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-360-9550
Mailing Address - Street 1:6915 YELLOWSTONE BLVD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-9406
Mailing Address - Country:US
Mailing Address - Phone:718-360-9550
Mailing Address - Fax:
Practice Address - Street 1:6915 YELLOWSTONE BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-9406
Practice Address - Country:US
Practice Address - Phone:718-360-9550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-19
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QL0400XAmbulatory Health Care FacilitiesClinic/CenterLithotripsyGroup - Single Specialty