Provider Demographics
NPI:1245423599
Name:MIDDLETOWN UROLOGIC ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:MIDDLETOWN UROLOGIC ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-343-4141
Mailing Address - Street 1:25 MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-4122
Mailing Address - Country:US
Mailing Address - Phone:845-343-4141
Mailing Address - Fax:845-343-1535
Practice Address - Street 1:110 BRIDGEVILLE RD
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:NY
Practice Address - Zip Code:12701-3855
Practice Address - Country:US
Practice Address - Phone:845-343-4141
Practice Address - Fax:845-343-1535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0451600001Medicare NSC