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NPI Code Detail

MEDICARE: NEW JERSEY CENTER FOR PROSTATE CANCER AND UROLOGY, PC

MEDICARE: NEW JERSEY CENTER FOR PROSTATE CANCER AND UROLOGY, PC
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
1174400000XSpecialist

General Provider Information

NPI Number : 1447351762
Entity Type Code : Organization
Provider Name (Legal Business Name) : NEW JERSEY CENTER FOR PROSTATE CANCER AND UROLOGY, PC
Provider Business Mailing Address
First Line : 255 W SPRING VALLEY AVE
Second Line : SUITE 101
City : MAYWOOD
State : NJ
Zip : 07607-1445
Country : US
Telephone Number : 201-487-8866
Fax Number : 201-487-2610
Provider Business Practice Location Address
First Line : 255 W SPRING VALLEY AVE
Second Line : SUITE 101
City : MAYWOOD
State : NJ
Zip : 07607-1445
Country : US
Telephone Number : 201-487-8866
Fax Number : 201-487-2610
Authorized Official
Title or Position : OFFICE MANAGER
Name : LIZ PICARDO
Credential :
Telephone Number : 201-487-8866
Provider Enumeration Date : 09/26/2006
Last Update Date : 05/21/2008

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Directions to “NEW JERSEY CENTER FOR PROSTATE CANCER AND UROLOGY, PC ” Practice Location

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