Provider Demographics
NPI:1205033099
Name:ASSOCIATED ADVANCED ADULT & PEDIATRIC UROLOGY PC
Entity Type:Organization
Organization Name:ASSOCIATED ADVANCED ADULT & PEDIATRIC UROLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:BHUPENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:TOLIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-904-0411
Mailing Address - Street 1:1695 EASTCHESTER RD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-2374
Mailing Address - Country:US
Mailing Address - Phone:718-904-0411
Mailing Address - Fax:
Practice Address - Street 1:1695 EASTCHESTER RD
Practice Address - Street 2:SUITE 306
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-2374
Practice Address - Country:US
Practice Address - Phone:718-904-0411
Practice Address - Fax:718-904-0222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY111622208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1205033099Medicare NSC
NYC11455Medicare UPIN