Premier Urology Group LLC

Primary specialty

SpecialistTaxonomy code 174400000X

License

25MA05567600 Issued in NJ

Legal business name

PREMIER UROLOGY GROUP LLC

Practice address

3 Hospital PLZ
Suite 200
Old Bridge, NJ 08857-3093

Phone

(732) 679-2010

NPI assigned

Mar 1, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Benjamin Fand, MD

Title

MD

Phone

(732) 679-2010

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1267401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1282003200000",
    "number": "1376866616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 HOSPITAL PLZ",
            "address_2": "SUITE 200",
            "city": "OLD BRIDGE",
            "state": "NJ",
            "postal_code": "088573093",
            "telephone_number": "732-679-2010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 HOSPITAL PLZ",
            "address_2": "SUITE 200",
            "city": "OLD BRIDGE",
            "state": "NJ",
            "postal_code": "088573093",
            "telephone_number": "732-679-2010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER UROLOGY GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-01",
        "last_updated": "2010-08-17",
        "status": "A",
        "authorized_official_last_name": "FAND",
        "authorized_official_first_name": "BENJAMIN",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "732-679-2010",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "NJ",
            "license": "25MA05567600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Old Bridge, NJ
• Providers in Old Bridge, NJ by specialty
• Specialist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.