Provider Demographics
NPI:1194867275
Name:MID-ESSEX UROLOGY ASSOCIATES
Entity Type:Organization
Organization Name:MID-ESSEX UROLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:A
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:973-677-1144
Mailing Address - Street 1:258 CENTRAL AVE # 264
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07050-3414
Mailing Address - Country:US
Mailing Address - Phone:973-677-1144
Mailing Address - Fax:973-677-9145
Practice Address - Street 1:258 CENTRAL AVE # 264
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07050-3414
Practice Address - Country:US
Practice Address - Phone:973-677-1144
Practice Address - Fax:973-677-9145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ527249Medicare ID - Type UnspecifiedPROVIDER ID NUMBER