Provider Demographics
NPI:1053544528
Name:PREMIER UROLOGY ASSOCIATES, LLC
Entity type:Organization
Organization Name:PREMIER UROLOGY ASSOCIATES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PLOTKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-896-2950
Mailing Address - Street 1:3131 PRINCETON PIKE
Mailing Address - Street 2:BLDG. 4, SUITE 212
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648
Mailing Address - Country:US
Mailing Address - Phone:609-896-2950
Mailing Address - Fax:609-896-2951
Practice Address - Street 1:859 TOWN CENTER DR
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1752
Practice Address - Country:US
Practice Address - Phone:609-896-2950
Practice Address - Fax:609-896-2951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-31
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208800000X
NJ25MA05468300208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0061425Medicaid
NJ174498Medicare PIN
NJ174498Medicare UPIN
NJ0061425Medicaid