Provider Demographics
NPI:1316990690
Name:UROLOGIC INSTITUTE OF NJ PA
Entity type:Organization
Organization Name:UROLOGIC INSTITUTE OF NJ PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:H
Authorized Official - Last Name:VITENSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-489-8900
Mailing Address - Street 1:277 FOREST AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-5410
Mailing Address - Country:US
Mailing Address - Phone:201-489-8900
Mailing Address - Fax:201-489-0877
Practice Address - Street 1:277 FOREST AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-5410
Practice Address - Country:US
Practice Address - Phone:201-489-8900
Practice Address - Fax:201-489-0877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ550432Medicare ID - Type Unspecified