Provider Demographics
NPI:1972796068
Name:YORKTOWNE UROLOGY, PC
Entity Type:Organization
Organization Name:YORKTOWNE UROLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:S
Authorized Official - Last Name:ROGGENBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-741-9536
Mailing Address - Street 1:2350 FREEDOM WAY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-8261
Mailing Address - Country:US
Mailing Address - Phone:717-741-9536
Mailing Address - Fax:717-741-5509
Practice Address - Street 1:2350 FREEDOM WAY
Practice Address - Street 2:SUITE 102
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-8261
Practice Address - Country:US
Practice Address - Phone:717-741-9536
Practice Address - Fax:717-741-5509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007713350009Medicaid