Provider Demographics
NPI:1639341803
Name:UROLOGICAL ASSOCIATES OF LI, PC
Entity type:Organization
Organization Name:UROLOGICAL ASSOCIATES OF LI, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-475-5051
Mailing Address - Street 1:250 YAPHANK RD
Mailing Address - Street 2:STE 11B
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-4800
Mailing Address - Country:US
Mailing Address - Phone:631-475-5051
Mailing Address - Fax:631-475-5140
Practice Address - Street 1:300 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:GREENPORT
Practice Address - State:NY
Practice Address - Zip Code:11944-1203
Practice Address - Country:US
Practice Address - Phone:631-477-1885
Practice Address - Fax:631-477-0219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-28
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC14556OtherRAILROAD MEDICARE
NYWKW621Medicare PIN