Provider Demographics
NPI:1770508459
Name:CENTER FOR UROLOGIC CARE
Entity Type:Organization
Organization Name:CENTER FOR UROLOGIC CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:KARL
Authorized Official - Middle Name:H
Authorized Official - Last Name:EBERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-751-7772
Mailing Address - Street 1:502 CENTENNIAL BLVD
Mailing Address - Street 2:STE 2
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043
Mailing Address - Country:US
Mailing Address - Phone:856-751-7772
Mailing Address - Fax:856-751-5328
Practice Address - Street 1:502 CENTENNIAL BLVD
Practice Address - Street 2:STE 2
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043
Practice Address - Country:US
Practice Address - Phone:856-751-7772
Practice Address - Fax:856-751-5328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2636409Medicaid
NJ2636409Medicaid