Healthcare Provider Details

I. General information

NPI: 1790745396
Provider Name (Legal Business Name): UROLOGY SPECIALTY CARE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 04/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15-01 BROADWAY RT 4 WEST STE 1 & 3
FAIR LAWN NJ
07410
US

IV. Provider business mailing address

15-01 BROADWAY RT 4 WEST STE 1 & 3
FAIR LAWN NJ
07410
US

V. Phone/Fax

Practice location:
  • Phone: 201-791-4544
  • Fax: 201-791-4544
Mailing address:
  • Phone: 201-791-4544
  • Fax: 201-794-6970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: JOHN H HAJJAR
Title or Position: MD
Credential: MD
Phone: 201-791-4544