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General NPI Number Information
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NPI Number | 1477545705
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Entity Type | Organization
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Legal Business Name | LAWRENCEVILLE UROLOGY PA
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Dates
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Enumeration Date | 08/23/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3120 PRINCETON PIKE 1ST FLOOR
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City | LAWRENCEVILLE
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State | NJ
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Zip | 08648-2306
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Country | US
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Telephone | 609-895-1991
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Fax | 609-895-6996
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Provider Business Mailing Address
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Address Line | 3120 PRINCETON PIKE 1ST FLOOR
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City | LAWRENCEVILLE
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State | NJ
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Zip | 08648-2306
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Country | US
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Telephone | 609-895-1991
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Fax | 609-895-6996
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. THERESA C RYAN
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Credential | RN
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Telephone | 609-895-1991
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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 |
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License Number State |
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