Provider Demographics
NPI:1629267216
Name:TWENTY FIRST CENTURY UROLOGY PLLC
Entity Type:Organization
Organization Name:TWENTY FIRST CENTURY UROLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SAPAN
Authorized Official - Middle Name:
Authorized Official - Last Name:POLEPALLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-346-5815
Mailing Address - Street 1:47 MANSION RIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-5569
Mailing Address - Country:US
Mailing Address - Phone:845-346-5815
Mailing Address - Fax:
Practice Address - Street 1:47 MANSION RIDGE BLVD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-5569
Practice Address - Country:US
Practice Address - Phone:845-346-5815
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY239371208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty