Provider Demographics
NPI:1932107034
Name:UROLOGY ASSOCIATES OF DANBURY PC
Entity Type:Organization
Organization Name:UROLOGY ASSOCIATES OF DANBURY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BECK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-748-0330
Mailing Address - Street 1:51-53 KENOSIA AVE
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-2301
Mailing Address - Country:US
Mailing Address - Phone:203-748-0330
Mailing Address - Fax:203-797-0255
Practice Address - Street 1:51-53 KENOSIA AVE
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-2301
Practice Address - Country:US
Practice Address - Phone:203-748-0330
Practice Address - Fax:203-797-0255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004125838Medicaid
CTC00930OtherMEDICARE PTAN
CTC00930Medicare UPIN