Provider Demographics
NPI:1841668456
Name:UROLOGY GROUP OF NJ LLC
Entity type:Organization
Organization Name:UROLOGY GROUP OF NJ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:DREYFUSS
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:973-323-1366
Mailing Address - Street 1:375 MOUNT PLEASANT AVE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-2750
Mailing Address - Country:US
Mailing Address - Phone:973-323-1320
Mailing Address - Fax:973-323-1329
Practice Address - Street 1:375 MOUNT PLEASANT AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-2750
Practice Address - Country:US
Practice Address - Phone:973-323-1320
Practice Address - Fax:973-323-1329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-14
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty