Basic Information
| Provider Information | |||||||||
| NPI: | 1407893274 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HUNTERDON UROLOGICAL ASSOCIATES, P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 121 HIGHWAY 31, SUITE 1200 | ||||||||
| Address2: | |||||||||
| City: | FLEMINGTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08822 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9087820019 | ||||||||
| FaxNumber: | 9087820630 | ||||||||
| Practice Location | |||||||||
| Address1: | 121 HIGHWAY 31, SUITE 1200 | ||||||||
| Address2: | |||||||||
| City: | FLEMINGTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08822 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9087820019 | ||||||||
| FaxNumber: | 9087820630 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2006 | ||||||||
| LastUpdateDate: | 05/11/2012 | ||||||||
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| AuthorizedOfficialLastName: | KERN | ||||||||
| AuthorizedOfficialFirstName: | ALLEN | ||||||||
| AuthorizedOfficialMiddleName: | J. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9087820019 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | NJ | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 2859203 | 05 | NJ | MEDICAID |