Healthcare Provider Details

I. General information

NPI: 1912219452
Provider Name (Legal Business Name): NEW YORK CITY UROLOGY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2010
Last Update Date: 07/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 E 77TH ST
NEW YORK NY
10075-2318
US

IV. Provider business mailing address

445 E 77TH ST
NEW YORK NY
10075-2318
US

V. Phone/Fax

Practice location:
  • Phone: 212-772-3900
  • Fax: 212-772-1919
Mailing address:
  • Phone: 212-772-3900
  • Fax: 212-772-1919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JERRY BLAIVAS
Title or Position: MEMBER
Credential: M.D.
Phone: 212-772-3900