Provider Demographics
NPI:1912007030
Name:PEDIATRIC UROLOGY ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:PEDIATRIC UROLOGY ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:FLEISHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-613-9144
Mailing Address - Street 1:557 CRANBURY RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-5419
Mailing Address - Country:US
Mailing Address - Phone:732-613-9144
Mailing Address - Fax:732-613-5121
Practice Address - Street 1:557 CRANBURY RD
Practice Address - Street 2:SUITE 4
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-5419
Practice Address - Country:US
Practice Address - Phone:732-613-9144
Practice Address - Fax:732-613-5121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty