Basic Information
| Provider Information | |||||||||
| NPI: | 1245310762 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HUNTINGTON UROLOGICAL ASSOC LAB | ||||||||
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| OtherOrganizationName: | HUNTINGTON UROLOGICAL ASSOC, INC | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2860 3RD AVENUE | ||||||||
| Address2: | SUITE 230 | ||||||||
| City: | HUNTINGTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 257021453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3045253711 | ||||||||
| FaxNumber: | 3045252748 | ||||||||
| Practice Location | |||||||||
| Address1: | 2860 3RD AVENUE | ||||||||
| Address2: | SUITE 230 | ||||||||
| City: | HUNTINGTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 257021453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3045253711 | ||||||||
| FaxNumber: | 3045252748 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2006 | ||||||||
| LastUpdateDate: | 01/11/2010 | ||||||||
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| AuthorizedOfficialLastName: | MORABITO | ||||||||
| AuthorizedOfficialFirstName: | ROCCO | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3045253711 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 0009178001 | 05 | WV | MEDICAID |