Provider Demographics
NPI:1962534453
Name:ADULT & PEDIATRIC UROLOGY OF HUNTERDON, PA
Entity type:Organization
Organization Name:ADULT & PEDIATRIC UROLOGY OF HUNTERDON, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JANUARY
Authorized Official - Middle Name:
Authorized Official - Last Name:HUMMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-751-5939
Mailing Address - Street 1:5 WALTER FORAN BLVD
Mailing Address - Street 2:SUITE 4001
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-4678
Mailing Address - Country:US
Mailing Address - Phone:908-751-5939
Mailing Address - Fax:908-751-5938
Practice Address - Street 1:5 WALTER FORAN BLVD
Practice Address - Street 2:SUITE 4001
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-4678
Practice Address - Country:US
Practice Address - Phone:908-751-5939
Practice Address - Fax:908-751-5938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-10
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA72254208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ141147Medicare PIN