Provider Demographics
NPI:1477573996
Name:ADULT & PEDIATRIC UROLOGY CENTER, PA
Entity Type:Organization
Organization Name:ADULT & PEDIATRIC UROLOGY CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BURTON
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCHLECKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-473-5700
Mailing Address - Street 1:1033 CLIFTON AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-3517
Mailing Address - Country:US
Mailing Address - Phone:973-473-5700
Mailing Address - Fax:973-473-3367
Practice Address - Street 1:1033 CLIFTON AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-3517
Practice Address - Country:US
Practice Address - Phone:973-473-5700
Practice Address - Fax:973-473-3367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA47849208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJCA0533OtherRAILROAD MEDICARE GROUP#
NJ4555795OtherAETNA PPO GROUP#
NJ0113605000OtherAMERIHEALTH GROUP#
NJ0470398OtherAETNA HMO GROUP#
NJ526449Medicare PIN
NJ0470398OtherAETNA HMO GROUP#