Provider Demographics
NPI:1932379161
Name:EAST HUDSON UROLOGY GROUP PC
Entity Type:Organization
Organization Name:EAST HUDSON UROLOGY GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:H
Authorized Official - Last Name:FAGIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-739-1219
Mailing Address - Street 1:1985 CROMPOND ROAD
Mailing Address - Street 2:BLDG D
Mailing Address - City:CORTLANDT MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10567
Mailing Address - Country:US
Mailing Address - Phone:914-739-1219
Mailing Address - Fax:914-739-2353
Practice Address - Street 1:1985 CROMPOND ROAD
Practice Address - Street 2:BLDG D
Practice Address - City:CORTLANDT MANOR
Practice Address - State:NY
Practice Address - Zip Code:10567
Practice Address - Country:US
Practice Address - Phone:914-739-1219
Practice Address - Fax:914-739-2353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY95F351Medicare Oscar/Certification
NY61T281Medicare Oscar/Certification
NY663512Medicare Oscar/Certification