Provider Demographics
NPI:1619199452
Name:UROLOGICAL ASSOCIATES OF BRIDGEPORT PROF.CORP.
Entity Type:Organization
Organization Name:UROLOGICAL ASSOCIATES OF BRIDGEPORT PROF.CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:VINER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-375-3456
Mailing Address - Street 1:160 HAWLEY LANE
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-5300
Mailing Address - Country:US
Mailing Address - Phone:203-375-3456
Mailing Address - Fax:203-375-4456
Practice Address - Street 1:160 HAWLEY LANE
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-5300
Practice Address - Country:US
Practice Address - Phone:203-375-3456
Practice Address - Fax:203-375-4456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT14383174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTCLPOL 0082OtherSTATE OF CT