Provider Demographics
NPI:1447351762
Name:NEW JERSEY CENTER FOR PROSTATE CANCER AND UROLOGY, PC
Entity type:Organization
Organization Name:NEW JERSEY CENTER FOR PROSTATE CANCER AND UROLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:PICARDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-487-8866
Mailing Address - Street 1:255 W SPRING VALLEY AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MAYWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07607-1445
Mailing Address - Country:US
Mailing Address - Phone:201-487-8866
Mailing Address - Fax:201-487-2610
Practice Address - Street 1:255 W SPRING VALLEY AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:MAYWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07607-1445
Practice Address - Country:US
Practice Address - Phone:201-487-8866
Practice Address - Fax:201-487-2610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ048885Medicare ID - Type Unspecified