Healthcare Provider Details

I. General information

NPI: 1366533598
Provider Name (Legal Business Name): UROLOGY ASSOCIATES OF KINGSTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 02/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 S RIVER ST STE 301
PLAINS PA
18705-1032
US

IV. Provider business mailing address

670 S RIVER ST STE 301
PLAINS PA
18705-1032
US

V. Phone/Fax

Practice location:
  • Phone: 570-270-2600
  • Fax: 570-270-2828
Mailing address:
  • Phone: 570-270-2600
  • Fax: 570-270-2828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JACKIE ZAMPETTI
Title or Position: OFFICE MANAGER
Credential:
Phone: 570-270-2600