Provider Demographics
NPI:1780603951
Name:WASHINGTON HEIGHTS UROLOGY PC
Entity type:Organization
Organization Name:WASHINGTON HEIGHTS UROLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:J
Authorized Official - Last Name:CONTRERAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-781-9696
Mailing Address - Street 1:286 FT WASHINGTON AVE
Mailing Address - Street 2:#1A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032
Mailing Address - Country:US
Mailing Address - Phone:212-781-9696
Mailing Address - Fax:212-568-7138
Practice Address - Street 1:286 FT WASHINGTON AVE
Practice Address - Street 2:#1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032
Practice Address - Country:US
Practice Address - Phone:212-781-9696
Practice Address - Fax:212-568-7138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY115993208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00214686Medicaid
NY305211Medicare ID - Type Unspecified
D39020Medicare UPIN