Provider Demographics
NPI:1174398903
Name:ADVANCED UROLOGY ASSOCIATES ENTERPRISES
Entity type:Organization
Organization Name:ADVANCED UROLOGY ASSOCIATES ENTERPRISES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BONITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-741-5923
Mailing Address - Street 1:595 SHREWSBURY AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:07702-4159
Mailing Address - Country:US
Mailing Address - Phone:732-741-5923
Mailing Address - Fax:
Practice Address - Street 1:595 SHREWSBURY AVE STE 103
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702-4159
Practice Address - Country:US
Practice Address - Phone:732-741-5923
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-21
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site