Provider Demographics
NPI:1336337328
Name:JSMK UROLOGY P.C.
Entity Type:Organization
Organization Name:JSMK UROLOGY P.C.
Other - Org Name:JOHN H WON UROLOGY PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:WON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-888-7800
Mailing Address - Street 1:4161 KISSENA BLVD
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355
Mailing Address - Country:US
Mailing Address - Phone:718-888-7800
Mailing Address - Fax:718-888-7377
Practice Address - Street 1:400 SYLVAN AVE STE 108
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD CLIFFS
Practice Address - State:NJ
Practice Address - Zip Code:07632-2717
Practice Address - Country:US
Practice Address - Phone:718-888-7800
Practice Address - Fax:718-888-7377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA072566208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ079772Medicare PIN