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NPI Code Detail

MEDICARE: ESSEX HUDSON UROLOGY PC

MEDICARE: ESSEX HUDSON UROLOGY PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist

General Provider Information

NPI Number : 1073551016
Entity Type Code : Organization
Provider Name (Legal Business Name) : ESSEX HUDSON UROLOGY PC
Provider Business Mailing Address
First Line : PO BOX 550
Second Line :
City : BELLEVILLE
State : NJ
Zip : 07109-0550
Country : US
Telephone Number : 201-225-9254
Fax Number : 201-225-9254
Provider Business Practice Location Address
First Line : 256 BROAD ST
Second Line :
City : BLOOMFIELD
State : NJ
Zip : 07003-2766
Country : US
Telephone Number : 973-743-4450
Fax Number : 973-429-9076
Authorized Official
Title or Position : MANAGER
Name : JEANNE M MINCK
Credential :
Telephone Number : 201-225-9254
Provider Enumeration Date : 06/03/2006
Last Update Date : 08/22/2020

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