Provider Demographics
NPI:1588851463
Name:GENITO URINARY ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:GENITO URINARY ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:H
Authorized Official - Last Name:READ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-455-5770
Mailing Address - Street 1:20 MAGNOLIA AVE
Mailing Address - Street 2:STE D
Mailing Address - City:BRIDGETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08302-1759
Mailing Address - Country:US
Mailing Address - Phone:856-455-5770
Mailing Address - Fax:856-453-8458
Practice Address - Street 1:20 MAGNOLIA AVE
Practice Address - Street 2:STE D
Practice Address - City:BRIDGETON
Practice Address - State:NJ
Practice Address - Zip Code:08302-1759
Practice Address - Country:US
Practice Address - Phone:856-455-5770
Practice Address - Fax:856-453-8458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA03173600208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2248301Medicaid
NJ2248301Medicaid
NJ009001Medicare PIN