Provider Demographics
NPI:1629124003
Name:NORTH BRONX UROLOGICAL SERVICES
Entity Type:Organization
Organization Name:NORTH BRONX UROLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-693-0700
Mailing Address - Street 1:1100 SHAMES DR
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-1765
Mailing Address - Country:US
Mailing Address - Phone:516-693-0700
Mailing Address - Fax:516-693-0271
Practice Address - Street 1:2016 BRONXDALE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-3388
Practice Address - Country:US
Practice Address - Phone:718-863-8695
Practice Address - Fax:718-863-5147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY196895208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01977513Medicaid
NYG75975Medicare UPIN
NY61T901Medicare ID - Type Unspecified