Provider Demographics
NPI:1235171760
Name:UNIVERSITY UROLOGY PA
Entity Type:Organization
Organization Name:UNIVERSITY UROLOGY PA
Other - Org Name:ROSENBERG & BASRALIAN, MD, PA
Other - Org Type:Other Name
Authorized Official - Title/Position:DELEGATED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:GENE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-343-0082
Mailing Address - Street 1:20 PROSPECT AVE
Mailing Address - Street 2:SUITE 719
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-1997
Mailing Address - Country:US
Mailing Address - Phone:201-343-0082
Mailing Address - Fax:
Practice Address - Street 1:20 PROSPECT AVE
Practice Address - Street 2:SUITE 719
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1997
Practice Address - Country:US
Practice Address - Phone:201-343-0082
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03648000174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2851785000OtherAMERIHEALTH HMO GROUP #
NJ3055507Medicaid
NJCA8379OtherRAILROAD MEDICARE GROUP #
NJ0466553OtherAETNA HMO GROUP #
NJ5854449OtherAETNA PPO GROUP #
NJ0466553OtherAETNA HMO GROUP #