Provider Demographics
NPI:1831190560
Name:EAST MOUNTAIN UROLOGY ASSOCIATES, P.C.
Entity type:Organization
Organization Name:EAST MOUNTAIN UROLOGY ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:KURZWEIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-829-1221
Mailing Address - Street 1:1212 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SWOYERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18704-1318
Mailing Address - Country:US
Mailing Address - Phone:570-829-1221
Mailing Address - Fax:570-829-4468
Practice Address - Street 1:1212 MAIN ST
Practice Address - Street 2:
Practice Address - City:SWOYERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18704-1318
Practice Address - Country:US
Practice Address - Phone:570-829-1221
Practice Address - Fax:570-829-4468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-03
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1272OtherGEISINGER HEALTH PLAN
ST523421Medicare ID - Type Unspecified