Provider Demographics
NPI:1891715694
Name:INDEPENDENCE UROLOGY INC
Entity Type:Organization
Organization Name:INDEPENDENCE UROLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:PIERRE
Authorized Official - Middle Name:Y
Authorized Official - Last Name:GHAYAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-622-7705
Mailing Address - Street 1:3001 GARRETT RD
Mailing Address - Street 2:STE B
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026
Mailing Address - Country:US
Mailing Address - Phone:610-622-7705
Mailing Address - Fax:610-284-6046
Practice Address - Street 1:3001 GARRETT RD
Practice Address - Street 2:STE B
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026
Practice Address - Country:US
Practice Address - Phone:610-622-7705
Practice Address - Fax:610-284-6046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA096698Medicare PIN