Provider Demographics
NPI:1881654630
Name:S.J.ANTOON UROLOGICAL ASSOCIATES, LTD.
Entity Type:Organization
Organization Name:S.J.ANTOON UROLOGICAL ASSOCIATES, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SALEEM
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:ANTOON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:724-337-8404
Mailing Address - Street 1:251 7TH ST
Mailing Address - Street 2:SUITE C202
Mailing Address - City:NEW KENSINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15068-6534
Mailing Address - Country:US
Mailing Address - Phone:724-337-8404
Mailing Address - Fax:724-337-4200
Practice Address - Street 1:251 7TH ST
Practice Address - Street 2:SUITE C202
Practice Address - City:NEW KENSINGTON
Practice Address - State:PA
Practice Address - Zip Code:15068-6534
Practice Address - Country:US
Practice Address - Phone:724-337-8404
Practice Address - Fax:724-337-4200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-24
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
PA1007706320001Medicaid
PA1008640OtherGATEWAY
PAS054442OtherHIGHMARK BLUE SHIELD
CF4123Medicare ID - Type UnspecifiedRAILROAD MEDICARE
PA1007706320001Medicaid