Healthcare Provider Details

I. General information

NPI: 1285679654
Provider Name (Legal Business Name): UROLOGICAL ASSOCIATES OF LI, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 01/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 YAPHANK RD STE 11B
EAST PATCHOGUE NY
11772-4800
US

IV. Provider business mailing address

250 YAPHANK RD STE 11B
EAST PATCHOGUE NY
11772-4800
US

V. Phone/Fax

Practice location:
  • Phone: 631-475-5051
  • Fax: 631-475-8268
Mailing address:
  • Phone: 631-475-5051
  • Fax: 631-475-8268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MRS. PATRICIA MARKIN
Title or Position: OFFICE MANAGER
Credential:
Phone: 631-475-5051