Provider Demographics
NPI:1427012897
Name:UROLOGY GROUP PA
Entity Type:Organization
Organization Name:UROLOGY GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:FREY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-444-7070
Mailing Address - Street 1:4 GODWIN AVENUE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07432
Mailing Address - Country:US
Mailing Address - Phone:201-444-7070
Mailing Address - Fax:201-444-7712
Practice Address - Street 1:4 GODWIN AVENUE
Practice Address - Street 2:
Practice Address - City:MIDLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07432
Practice Address - Country:US
Practice Address - Phone:201-444-7070
Practice Address - Fax:201-444-7712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-13
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ195070301Medicaid
NJ8247901Medicaid
NJ1126601Medicaid
NJ8248001Medicaid
NJ195070301Medicaid
G37055Medicare UPIN
A92200Medicare UPIN
D07187Medicare UPIN
NJ1126601Medicaid
G94354Medicare UPIN