Provider Demographics
NPI:1912219452
Name:NEW YORK CITY UROLOGY, PLLC
Entity Type:Organization
Organization Name:NEW YORK CITY UROLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAIVAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-772-3900
Mailing Address - Street 1:445 E 77TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-2318
Mailing Address - Country:US
Mailing Address - Phone:212-772-3900
Mailing Address - Fax:212-772-1919
Practice Address - Street 1:445 E 77TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-2318
Practice Address - Country:US
Practice Address - Phone:212-772-3900
Practice Address - Fax:212-772-1919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty