Provider Demographics
NPI:1467622324
Name:CRESCENT UROLOGICAL CARE LLC
Entity Type:Organization
Organization Name:CRESCENT UROLOGICAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:AZEEM
Authorized Official - Last Name:BHATTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-331-3532
Mailing Address - Street 1:1205 EASTON AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-1672
Mailing Address - Country:US
Mailing Address - Phone:732-325-0050
Mailing Address - Fax:732-325-0071
Practice Address - Street 1:1205 EASTON AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-1672
Practice Address - Country:US
Practice Address - Phone:732-325-0050
Practice Address - Fax:732-325-0071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08256000208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ147-596Medicare PIN