MEDICARE: UROFIRST CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	26NJ00131800	NJ

General Provider Information

NPI Number	:	1003018912
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UROFIRST CARE LLC

Provider Business Mailing Address
First Line	:	456 TIMBERLINE DR
Second Line	:	SUITE 2
City	:	MOUNT LAUREL
State	:	NJ
Zip	:	08054-2141
Country	:	US
Telephone Number	:	856-231-1778
Fax Number	:	856-231-1778

Provider Business Practice Location Address
First Line	:	456 TIMBERLINE DR
Second Line	:	SUITE 2
City	:	MOUNT LAUREL
State	:	NJ
Zip	:	08054-2141
Country	:	US
Telephone Number	:	856-231-1778
Fax Number	:	856-231-1778

Authorized Official
Title or Position	:	SOLE PROPRIETOR
Name	:	CYNTHIA MERKLING
Credential	:	MSN, APRN, BC
Telephone Number	:	856-231-1778

Provider Enumeration Date	:	06/03/2007
Last Update Date	:	08/22/2020

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