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General NPI Number Information
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NPI Number | 1740235597
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Entity Type | Organization
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Legal Business Name | ADVANCED ADULT & PEDIATRIC UROLOGY LLC
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Dates
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Enumeration Date | 05/23/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 300 MERCER ST APT 22D
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City | NEW YORK
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State | NY
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Zip | 10003-6724
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Country | US
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Telephone | 617-797-5090
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Fax | 212-228-3438
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Provider Business Mailing Address
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Address Line | 300 MERCER ST APT 22D
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City | NEW YORK
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State | NY
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Zip | 10003-6724
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Country | US
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Telephone | 617-797-5090
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Fax | 212-228-3438
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Authorized Official
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Title or Position | OWNER
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Name | DR. MATTHEW SHAHBANDI
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Credential | MD
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Telephone | 617-797-5090
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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 | MA76499
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License Number State | NJ
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