Provider Demographics
NPI:1528623626
Name:ADVANCED UROGYNECOLOGY ASSOCIATES
Entity type:Organization
Organization Name:ADVANCED UROGYNECOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:P
Authorized Official - Last Name:MICHALEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-775-7978
Mailing Address - Street 1:601 SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:ASBURY PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-5313
Mailing Address - Country:US
Mailing Address - Phone:732-775-7978
Mailing Address - Fax:732-988-2545
Practice Address - Street 1:601 SUNSET AVE
Practice Address - Street 2:
Practice Address - City:ASBURY PARK
Practice Address - State:NJ
Practice Address - Zip Code:07712-5313
Practice Address - Country:US
Practice Address - Phone:732-775-7978
Practice Address - Fax:732-988-2545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-03
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyUrogynecology and Reconstructive Pelvic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1528623626OtherCMS