Provider Demographics
NPI:1043533805
Name:PREMIER UROLOGY GROUP LLC
Entity Type:Organization
Organization Name:PREMIER UROLOGY GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:S
Authorized Official - Last Name:RING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-325-0091
Mailing Address - Street 1:743 NORTHFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-1107
Mailing Address - Country:US
Mailing Address - Phone:973-325-0091
Mailing Address - Fax:
Practice Address - Street 1:743 NORTHFIELD AVE
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-1107
Practice Address - Country:US
Practice Address - Phone:973-325-0091
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04379500174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty