Provider Demographics
NPI:1790873453
Name:MIDDLESEX UROLOGY, PC.
Entity Type:Organization
Organization Name:MIDDLESEX UROLOGY, PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHERYL
Authorized Official - Middle Name:A
Authorized Official - Last Name:MALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-347-8850
Mailing Address - Street 1:520 SAYBROOK RD
Mailing Address - Street 2:SUITE 100B
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-4700
Mailing Address - Country:US
Mailing Address - Phone:860-347-8850
Mailing Address - Fax:860-347-6774
Practice Address - Street 1:520 SAYBROOK RD
Practice Address - Street 2:SUITE 100B
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-4700
Practice Address - Country:US
Practice Address - Phone:860-347-8850
Practice Address - Fax:860-347-6774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001222751Medicaid
CT001160332Medicaid
CT001170919Medicaid
CT001346677Medicaid
CT001170919Medicaid
CT001222751Medicaid
CTG10481Medicare UPIN
CT340000271Medicare ID - Type Unspecified
CT340000270Medicare ID - Type Unspecified
CTB38460Medicare UPIN
CTD02747Medicare UPIN
CT340000154Medicare ID - Type Unspecified
C02118Medicare ID - Type Unspecified