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General NPI Number Information
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NPI Number | 1467622324
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Entity Type | Organization
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Legal Business Name | CRESCENT UROLOGICAL CARE LLC
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Dates
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Enumeration Date | 03/06/2008
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Last Update Date | 10/20/2014
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Provider Practice Location Address
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Address Line | 1205 EASTON AVE SUITE 201
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City | SOMERSET
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State | NJ
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Zip | 08873-1672
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Country | US
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Telephone | 732-325-0050
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Fax | 732-325-0071
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Provider Business Mailing Address
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Address Line | 1205 EASTON AVE SUITE 201
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City | SOMERSET
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State | NJ
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Zip | 08873-1672
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Country | US
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Telephone | 732-325-0050
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Fax | 732-325-0071
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Authorized Official
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Title or Position | PRESIDENT
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Name | MOHAMMAD AZEEM BHATTI
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Credential | M.D.
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Telephone | 908-331-3532
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 25MA08256000
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License Number State | NJ
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