Organization
PREMIER UROLOGY GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BENJAMIN FAND M.D. (OFFICER)
(732) 494-9400
Entity
Organization
Contact information
Practice address
10 PARSONAGE RD, SUITE 118, EDISON, NJ 08837-2429
(732) 949-9400
Mailing address
10 PARSONAGE RD, SUITE 118, EDISON, NJ 08837-2429
(732) 949-9400
Taxonomy
Speciality
Code
Description
License number
State
207ZC0006X
Clinical Pathology Physician
—
—
2085R0203X
Therapeutic Radiology Physician
—
—
208800000X
Urology Physician
Primary
—
—
Other
Enumeration date
11/04/2008
Last updated
03/06/2009
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