Provider Demographics
NPI:1144429739
Name:UROLOGY ASSOCIATES OF NORWALK,PC
Entity Type:Organization
Organization Name:UROLOGY ASSOCIATES OF NORWALK,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:E
Authorized Official - Last Name:SHIELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-853-4200
Mailing Address - Street 1:12 ELMCREST TER
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06850-3937
Mailing Address - Country:US
Mailing Address - Phone:203-853-4200
Mailing Address - Fax:203-299-1938
Practice Address - Street 1:12 ELMCREST TER
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06850-3937
Practice Address - Country:US
Practice Address - Phone:203-853-4200
Practice Address - Fax:203-299-1938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-13
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004000816Medicaid
CT0449860001Medicare NSC