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General NPI Number Information
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NPI Number | 1104972678
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Entity Type | Organization
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Legal Business Name | NEW JERSEY UROLOGY ASSOCIATES,P.A.
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Dates
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Enumeration Date | 01/26/2007
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Last Update Date | 05/22/2008
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Provider Practice Location Address
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Address Line | 110 MEADOWLANDS PKWY # B SUITE 302
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City | SECAUCUS
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State | NJ
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Zip | 07094-2302
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Country | US
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Telephone | 201-867-1297
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Fax | 201-867-4165
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Provider Business Mailing Address
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Address Line | PO BOX 250
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City | SADDLE RIVER
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State | NJ
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Zip | 07458-0250
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Country | US
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Telephone | 201-962-3919
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Fax | 201-962-3698
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Authorized Official
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Title or Position | PRESIDENT-C.E.O.
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Name | IRA D TANZER
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Credential | M.D.
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Telephone | 201-788-2437
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MA030534
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License Number State | NJ
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