Provider Demographics
NPI:1255366605
Name:NORTHEASTERN UROLOGICAL ASSOCIATES
Entity type:Organization
Organization Name:NORTHEASTERN UROLOGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLISH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-634-2900
Mailing Address - Street 1:2314 E ALLEGHENY AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19134-4432
Mailing Address - Country:US
Mailing Address - Phone:215-634-2900
Mailing Address - Fax:215-634-5687
Practice Address - Street 1:2314 E ALLEGHENY AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-4432
Practice Address - Country:US
Practice Address - Phone:215-634-2900
Practice Address - Fax:215-634-5687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
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
PA06897OtherHEALTH PARTNERS
PA076967OtherBLUE CROSS PA
PW32522OtherKEYSTONE MERCY
PW0053477000OtherKEYSTONE
PACM5670OtherRAILROAD MEDICARE
PA0008824760002Medicaid
PA0008824760002Medicaid