Provider Demographics
NPI:1780712828
Name:POCONO UROLOGY ASSOC
Entity type:Organization
Organization Name:POCONO UROLOGY ASSOC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:GULICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-424-6800
Mailing Address - Street 1:175 EAST BROWN STREET
Mailing Address - Street 2:SUITE 102
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301
Mailing Address - Country:US
Mailing Address - Phone:570-424-6800
Mailing Address - Fax:570-424-7860
Practice Address - Street 1:175 EAST BROWN STREET
Practice Address - Street 2:SUITE 102
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301
Practice Address - Country:US
Practice Address - Phone:570-424-6800
Practice Address - Fax:570-424-7860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty