Provider Demographics
NPI:1598798878
Name:NEO UROLOGY ASSOCIATES INC
Entity Type:Organization
Organization Name:NEO UROLOGY ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:S
Authorized Official - Last Name:RICCHIUTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-729-9214
Mailing Address - Street 1:7430 SOUTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-5629
Mailing Address - Country:US
Mailing Address - Phone:330-729-9214
Mailing Address - Fax:330-729-9217
Practice Address - Street 1:7430 SOUTHERN BLVD
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-5629
Practice Address - Country:US
Practice Address - Phone:330-729-9214
Practice Address - Fax:330-729-9217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0716005Medicaid
OHCM8439Medicare PIN
OH0716005Medicaid