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General NPI Number Information
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NPI Number | 1922696228
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Entity Type | Organization
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Legal Business Name | EMPIRE UROLOGY LLC
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Dates
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Enumeration Date | 01/04/2021
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Last Update Date | 01/04/2021
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Provider Practice Location Address
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Address Line | 349 E NORTHFIELD RD STE 202
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City | LIVINGSTON
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State | NJ
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Zip | 07039-4806
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Country | US
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Telephone | 973-251-2055
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Fax | 973-251-2562
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Provider Business Mailing Address
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Address Line | 349 E NORTHFIELD RD STE 202
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City | LIVINGSTON
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State | NJ
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Zip | 07039-4806
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Country | US
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Telephone | 973-251-2055
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Fax | 973-251-2562
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. RON SAMUEL ISRAELI
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Credential | MD
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Telephone | 973-251-2055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2088P0231X
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Taxonomy Name | Pediatric Urology Physician
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License Number |
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License Number State |
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