Provider Demographics
NPI:1477692093
Name:NURZIA, MICHAEL J (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:NURZIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 MILL RIVER ST
Mailing Address - Street 2:SUITE 404
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-3733
Mailing Address - Country:US
Mailing Address - Phone:203-356-9391
Mailing Address - Fax:
Practice Address - Street 1:80 MILL RIVER ST
Practice Address - Street 2:SUITE 404
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-3733
Practice Address - Country:US
Practice Address - Phone:203-356-9391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT043171208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001431717Medicaid
CT001431717Medicaid
202316263OtherTIN
340000378Medicare ID - Type Unspecified