Provider Demographics
NPI:1518038140
Name:UROLOGY CENTER P A
Entity Type:Organization
Organization Name:UROLOGY CENTER P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DELEGATED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KATZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-816-1900
Mailing Address - Street 1:75 S DEAN ST
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-3512
Mailing Address - Country:US
Mailing Address - Phone:201-816-1900
Mailing Address - Fax:201-816-1777
Practice Address - Street 1:663 PALISADE AVE
Practice Address - Street 2:#304
Practice Address - City:CLIFFSIDE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07010-3012
Practice Address - Country:US
Practice Address - Phone:201-313-1933
Practice Address - Fax:201-313-9599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03291800174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ=========OtherTAX ID#
NJ5233590001Medicare NSC
NJ5233590002Medicare NSC