Organization
NEW JERSEY UROLOGY LLC
Active
Organization
NEW JERSEY UROLOGY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VICTOR HOUTZ (CHIEF OPERATING OFFICER)
(973) 873-7000
Entity
Organization
Contact information
Practice address
1515 BROAD ST, SUITE B130, BLOOMFIELD, NJ 07003-3002
(973) 873-7000
(973) 743-8943
Mailing address
1515 BROAD ST, SUITE B130, BLOOMFIELD, NJ 07003-3002
(973) 873-7000
(973) 743-8943
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
25MA02050900
NJ
208800000X
Urology Physician
Primary
25MA02050900
NJ
291U00000X
Clinical Medical Laboratory
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
31D1104853
CLIA
—
01
—
D08754
MEDICARE RAILROAD
—
Enumeration date
05/28/2008
Last updated
07/24/2015
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