=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083904148
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UROLOGIC THERAPIES PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/11/2011
-----------------------------------------------------
Last Update Date | 04/11/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 242 E 72ND ST SUITE 1B
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10021-4574
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-535-5888
-----------------------------------------------------
Fax | 212-535-0961
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2448 LENOX HILL STATION
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-963-8112
-----------------------------------------------------
Fax | 914-963-8116
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MD
-----------------------------------------------------
Name | BENJAMIN B CHOI
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 212-535-5888
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208800000X
-----------------------------------------------------
Taxonomy Name | Urology Physician
-----------------------------------------------------
License Number | 202976
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------