Provider Demographics
NPI:1457342990
Name:NORTHTOW UROLOGY ASSOCIATES PC
Entity Type:Organization
Organization Name:NORTHTOW UROLOGY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROEHMHOLDT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-834-0100
Mailing Address - Street 1:3580 SHERIDAN DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-1645
Mailing Address - Country:US
Mailing Address - Phone:716-834-0100
Mailing Address - Fax:716-834-1161
Practice Address - Street 1:3580 SHERIDAN DR
Practice Address - Street 2:SUITE 150
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-1645
Practice Address - Country:US
Practice Address - Phone:716-834-0100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY024881Medicare ID - Type Unspecified