Provider Demographics
NPI:1811168164
Name:UROLOGIC SPECIALISTS OF NEW ENGLAND LLC
Entity type:Organization
Organization Name:UROLOGIC SPECIALISTS OF NEW ENGLAND LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:M
Authorized Official - Last Name:CAREY
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:401-828-7110
Mailing Address - Street 1:207 QUAKER LN
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:WEST WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02893-2179
Mailing Address - Country:US
Mailing Address - Phone:401-828-7110
Mailing Address - Fax:401-827-6364
Practice Address - Street 1:207 QUAKER LN
Practice Address - Street 2:1ST FLOOR
Practice Address - City:WEST WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02893-2179
Practice Address - Country:US
Practice Address - Phone:401-828-7110
Practice Address - Fax:401-827-6364
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UROLOGIC SPECIALISTS OF NEW ENGLAND LLCLAJOHNSO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-14
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPHS00004261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical