Provider Demographics
NPI:1235569898
Name:ADVANCED UROLOGY OF NEW ENGLAND, LLC
Entity Type:Organization
Organization Name:ADVANCED UROLOGY OF NEW ENGLAND, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:E
Authorized Official - Last Name:BRECHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-318-4670
Mailing Address - Street 1:40 CRANE AVE
Mailing Address - Street 2:
Mailing Address - City:EAST LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01028-2335
Mailing Address - Country:US
Mailing Address - Phone:413-318-4670
Mailing Address - Fax:413-754-0221
Practice Address - Street 1:40 CRANE AVE
Practice Address - Street 2:
Practice Address - City:EAST LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01028-2335
Practice Address - Country:US
Practice Address - Phone:413-318-4670
Practice Address - Fax:413-754-0221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-19
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA238159174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty