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General NPI Number Information
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NPI Number | 1689997447
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Entity Type | Organization
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Legal Business Name | PREMIER UROLOGY GROUP LLC
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Dates
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Enumeration Date | 03/09/2010
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Last Update Date | 08/17/2010
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Provider Practice Location Address
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Address Line | 776 E 3RD AVE
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City | ROSELLE
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State | NJ
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Zip | 07203-1698
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Country | US
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Telephone | 908-241-5268
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Fax |
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Provider Business Mailing Address
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Address Line | 776 E 3RD AVE
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City | ROSELLE
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State | NJ
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Zip | 07203-1698
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Country | US
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Telephone | 908-241-5268
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Fax |
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Authorized Official
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Title or Position | MD
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Name | KENNETH S RING
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Credential | MD
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Telephone | 908-241-5268
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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 | 25MA04379500
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License Number State | NJ
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