Provider Demographics
NPI:1780736686
Name:UROLOGY FOR CHILDREN LLC
Entity type:Organization
Organization Name:UROLOGY FOR CHILDREN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:DEAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-751-7880
Mailing Address - Street 1:200 BOWMAN DR
Mailing Address - Street 2:SUITE E360
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-9623
Mailing Address - Country:US
Mailing Address - Phone:856-751-7880
Mailing Address - Fax:856-751-9133
Practice Address - Street 1:200 BOWMAN DR
Practice Address - Street 2:SUITE E360
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-9623
Practice Address - Country:US
Practice Address - Phone:856-751-7880
Practice Address - Fax:856-751-9133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA25MA068251002088P0231X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric UrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8699607Medicaid
PA1871584101Medicaid