Provider Demographics
NPI:1851307300
Name:UROLOGY GROUP OF PRINCETON PA
Entity Type:Organization
Organization Name:UROLOGY GROUP OF PRINCETON PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHIASEN
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:609-924-6487
Mailing Address - Street 1:281 WITHERSPOON ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-3210
Mailing Address - Country:US
Mailing Address - Phone:609-924-6487
Mailing Address - Fax:609-921-7020
Practice Address - Street 1:281 WITHERSPOON ST
Practice Address - Street 2:SUITE 100
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-3210
Practice Address - Country:US
Practice Address - Phone:609-924-6487
Practice Address - Fax:609-921-7020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty