Provider Demographics
NPI:1861420564
Name:TARASUK & FARRELL UROLOGIOCAL ASSOCIATED
Entity type:Organization
Organization Name:TARASUK & FARRELL UROLOGIOCAL ASSOCIATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:TARASUK
Authorized Official - Suffix:
Authorized Official - Credentials:MD,PC
Authorized Official - Phone:718-353-3710
Mailing Address - Street 1:5842 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-5336
Mailing Address - Country:US
Mailing Address - Phone:718-353-3710
Mailing Address - Fax:718-463-0400
Practice Address - Street 1:5842 MAIN ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-5336
Practice Address - Country:US
Practice Address - Phone:718-353-3710
Practice Address - Fax:718-463-0400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY094925208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY51310Medicare PIN
NYC17175Medicare PIN