Provider Demographics
NPI:1699922443
Name:MID-JERSEY UROLOGY, LLC
Entity type:Organization
Organization Name:MID-JERSEY UROLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-561-2058
Mailing Address - Street 1:333 FORSGATE DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:JAMESBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-1567
Mailing Address - Country:US
Mailing Address - Phone:732-561-2058
Mailing Address - Fax:732-561-2061
Practice Address - Street 1:333 FORSGATE DR
Practice Address - Street 2:SUITE 202
Practice Address - City:JAMESBURG
Practice Address - State:NJ
Practice Address - Zip Code:08831-1567
Practice Address - Country:US
Practice Address - Phone:732-561-2058
Practice Address - Fax:732-561-2061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-23
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA69030208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG02005Medicare UPIN