Provider Demographics
NPI:1730257890
Name:S.J.ANTOON UROLOGICAL ASSOC.
Entity type:Organization
Organization Name:S.J.ANTOON UROLOGICAL ASSOC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SALEEM
Authorized Official - Middle Name:J
Authorized Official - Last Name:ANTOON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-337-8404
Mailing Address - Street 1:251 SEVENTH STREET
Mailing Address - Street 2:SUITE C202
Mailing Address - City:NEW KENSINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15068-6534
Mailing Address - Country:US
Mailing Address - Phone:724-337-8404
Mailing Address - Fax:724-337-4200
Practice Address - Street 1:251 7TH ST
Practice Address - Street 2:SUITE C202
Practice Address - City:NEW KENSINGTON
Practice Address - State:PA
Practice Address - Zip Code:15068-6534
Practice Address - Country:US
Practice Address - Phone:724-337-8404
Practice Address - Fax:724-337-4200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-022859-L291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006869660003Medicaid
PAC26405Medicare UPIN
PA0006869660003Medicaid