Provider Demographics
NPI:1730167875
Name:PALM BEACH UROLOGY ASSOCIATES PA
Entity type:Organization
Organization Name:PALM BEACH UROLOGY ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NADYA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRIETO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-790-2111
Mailing Address - Street 1:12953 PALMS WEST DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-4990
Mailing Address - Country:US
Mailing Address - Phone:561-790-2111
Mailing Address - Fax:561-790-0893
Practice Address - Street 1:12953 PALMS WEST DR
Practice Address - Street 2:SUITE 201
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-4990
Practice Address - Country:US
Practice Address - Phone:561-790-2111
Practice Address - Fax:561-790-0893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-09
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2 052637100Medicaid
FL2 052637100Medicaid