Provider Demographics
NPI:1073549721
Name:SOMERS POINT UROLOGY ASSOCIATES,P.A.
Entity Type:Organization
Organization Name:SOMERS POINT UROLOGY ASSOCIATES,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:JUNE
Authorized Official - Last Name:TADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-653-8046
Mailing Address - Street 1:403 BETHEL RD
Mailing Address - Street 2:
Mailing Address - City:SOMERS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08244-2188
Mailing Address - Country:US
Mailing Address - Phone:609-653-8046
Mailing Address - Fax:609-601-1406
Practice Address - Street 1:403 BETHEL RD
Practice Address - Street 2:
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244-2188
Practice Address - Country:US
Practice Address - Phone:609-653-8046
Practice Address - Fax:609-601-1406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ423307Medicare ID - Type UnspecifiedGROUP NUMBER