Provider Demographics
NPI:1821298852
Name:UROLOGICAL SPECIALISTS OF SOUTHERN NEW JERSEY LLC
Entity Type:Organization
Organization Name:UROLOGICAL SPECIALISTS OF SOUTHERN NEW JERSEY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BLOCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-651-0500
Mailing Address - Street 1:2301 EVESHAM ROAD
Mailing Address - Street 2:SUITE 508
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043
Mailing Address - Country:US
Mailing Address - Phone:856-651-0500
Mailing Address - Fax:856-651-0700
Practice Address - Street 1:2301 EVESHAM ROAD
Practice Address - Street 2:SUITE 508
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043
Practice Address - Country:US
Practice Address - Phone:856-651-0500
Practice Address - Fax:856-651-0700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ25MA4980700208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
D06850Medicare UPIN
NJBL577825Medicare PIN