Provider Demographics
NPI:1477545705
Name:LAWRENCEVILLE UROLOGY PA
Entity Type:Organization
Organization Name:LAWRENCEVILLE UROLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:C
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:609-895-1991
Mailing Address - Street 1:3120 PRINCETON PIKE
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-2306
Mailing Address - Country:US
Mailing Address - Phone:609-895-1991
Mailing Address - Fax:609-895-6996
Practice Address - Street 1:3120 PRINCETON PIKE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-2306
Practice Address - Country:US
Practice Address - Phone:609-895-1991
Practice Address - Fax:609-895-6996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ597174Medicare ID - Type Unspecified