Provider Demographics
NPI:1558394585
Name:TWIN RIVERS UROLOGY, P.C.
Entity Type:Organization
Organization Name:TWIN RIVERS UROLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:KLINE
Authorized Official - Suffix:
Authorized Official - Credentials:BILLING
Authorized Official - Phone:908-387-9207
Mailing Address - Street 1:PO BOX 69
Mailing Address - Street 2:
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08865-0069
Mailing Address - Country:US
Mailing Address - Phone:908-387-9207
Mailing Address - Fax:908-387-9311
Practice Address - Street 1:388 MEMORIAL PKWY
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-1535
Practice Address - Country:US
Practice Address - Phone:908-387-9207
Practice Address - Fax:908-387-9311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01501467Medicaid
NJ6100708Medicaid
=========OtherTAX ID #
PA01501467Medicaid
NJ6100708Medicaid
D20674Medicare UPIN