Provider Demographics
NPI:1821083734
Name:ADULT & PEDIATRIC UROLOGY GROUP PA
Entity Type:Organization
Organization Name:ADULT & PEDIATRIC UROLOGY GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FALCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-539-2119
Mailing Address - Street 1:261 JAMES ST
Mailing Address - Street 2:SUITE 3A
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-6392
Mailing Address - Country:US
Mailing Address - Phone:973-539-2119
Mailing Address - Fax:
Practice Address - Street 1:261 JAMES ST
Practice Address - Street 2:SUITE 3A
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-6392
Practice Address - Country:US
Practice Address - Phone:973-539-2119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-16
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJSCI090OtherOXFORD GROUP#
NJ339172OtherUNITED HEALTHCARE
NJCN5036OtherRAILROAD MC GRP#
NJSCI090OtherOXFORD GROUP#