Provider Demographics
NPI:1770531931
Name:NEW ALBANY UROLOGY, PLLC
Entity type:Organization
Organization Name:NEW ALBANY UROLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-539-0233
Mailing Address - Street 1:PO BOX 777
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:MS
Mailing Address - Zip Code:38652-0777
Mailing Address - Country:US
Mailing Address - Phone:662-539-0233
Mailing Address - Fax:662-538-0996
Practice Address - Street 1:303 J. H. PHILLIPS LANE
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:MS
Practice Address - Zip Code:38652-2428
Practice Address - Country:US
Practice Address - Phone:662-539-0233
Practice Address - Fax:662-538-0996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS17918174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03105381Medicaid
MS07752582Medicaid
MSP00051759OtherRAILROAD MEDICARE
MSE47923Medicare UPIN