Provider Demographics
NPI:1740375823
Name:UROLOGICAL SURGICAL ASSOCIATES, PA
Entity type:Organization
Organization Name:UROLOGICAL SURGICAL ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:JEROLD
Authorized Official - Middle Name:
Authorized Official - Last Name:GRUBMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-679-2010
Mailing Address - Street 1:10 PARSONAGE RD
Mailing Address - Street 2:SUITE 118
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08837-2429
Mailing Address - Country:US
Mailing Address - Phone:732-494-9400
Mailing Address - Fax:
Practice Address - Street 1:3 HOSPITAL PLZ
Practice Address - Street 2:SUITE 200
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-3093
Practice Address - Country:US
Practice Address - Phone:732-679-2010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02705000174400000X
NJ25MA03473500174400000X
NJ25MA04379500174400000X
NJ25MA05771900174400000X
NJ25MA07259700174400000X
NJ25MA07737800174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5739960002OtherDME EDISON
NJCB7278OtherRAILROAD MEDICARE GROUP #
NJ0563141OtherAETNA HMO GROUP #
NJ4229622OtherAETNA PPO GROUP #
NJ5739960001OtherDME OLD BRIDGE
NJ=========OtherTAX ID #
NJ5739960002OtherDME EDISON