Healthcare Provider Details

I. General information

NPI: 1619199452
Provider Name (Legal Business Name): UROLOGICAL ASSOCIATES OF BRIDGEPORT PROF.CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 11/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 HAWLEY LANE
TRUMBULL CT
06611-5300
US

IV. Provider business mailing address

160 HAWLEY LANE
TRUMBULL CT
06611-5300
US

V. Phone/Fax

Practice location:
  • Phone: 203-375-3456
  • Fax: 203-375-4456
Mailing address:
  • Phone: 203-375-3456
  • Fax: 203-375-4456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number14383
License Number StateCT

VIII. Authorized Official

Name: DR. NICHOLAS A VINER
Title or Position: PHYSICIAN
Credential: MD
Phone: 203-375-3456