Organization
ALBUQUERQUE UROLOGY ASSOCIATES, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JONATHAN EDWARD LACKNER M.D. (PARTNER / M.D.)
(505) 242-3991
Entity
Organization
Contact information
Practice address
610 BROADWAY BLVD NE, ALBUQUERQUE, NM 87102-2372
(505) 242-3991
(505) 243-8405
Mailing address
610 BROADWAY BLVD NE, ALBUQUERQUE, NM 87102-2372
(505) 242-3991
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
6682460001
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
44361
—
NM
01
—
CS1373
RAILROAD MEDICARE
NM
Enumeration date
07/15/2006
Last updated
07/31/2013
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