Provider Demographics
NPI:1427361005
Name:NEWARK-WAYNE UROLOGY PLLC
Entity Type:Organization
Organization Name:NEWARK-WAYNE UROLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:R
Authorized Official - Last Name:MADEB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-359-2690
Mailing Address - Street 1:1202 DRIVING PARK AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:NEWARK
Mailing Address - State:NY
Mailing Address - Zip Code:14513-1057
Mailing Address - Country:US
Mailing Address - Phone:315-359-2690
Mailing Address - Fax:315-359-2128
Practice Address - Street 1:1202 DRIVING PARK AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:NEWARK
Practice Address - State:NY
Practice Address - Zip Code:14513-1057
Practice Address - Country:US
Practice Address - Phone:315-359-2690
Practice Address - Fax:315-359-2128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-23
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ100025388Medicare PIN