Organization
LAKE SUCCESS UROLGICAL ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RUTH BORRERO (BILLING MANAGER)
(516) 437-4228
Entity
Organization
Contact information
Practice address
2001 MARCUS AVE, SUITE N-214, LAKE SUCCESS, NY 11042-1011
(516) 437-4228
(516) 355-0637
Mailing address
2001 MARCUS AVE, SUITE N-214, LAKE SUCCESS, NY 11042-1011
(516) 437-4228
(516) 355-0637
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C131591
RAILROAD MEDICARE B
GA
Enumeration date
06/30/2005
Last updated
07/21/2022
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