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General NPI Number Information
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NPI Number | 1144263989
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Entity Type | Organization
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Legal Business Name | THE UROLOGY CENTER PC
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Dates
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Enumeration Date | 06/13/2006
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Last Update Date | 10/27/2011
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Provider Practice Location Address
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Address Line | 330 ORCHARD ST SUITE 164
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City | NEW HAVEN
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State | CT
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Zip | 06511
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Country | US
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Telephone | 203-789-2222
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Fax | 203-624-3697
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Provider Business Mailing Address
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Address Line | 330 ORCHARD ST SUITE 164
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City | NEW HAVEN
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State | CT
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Zip | 06511
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Country | US
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Telephone | 203-789-2222
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Fax | 203-624-3697
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Authorized Official
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Title or Position | ADMISTRATOR
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Name | MR. WILLIAM PESANELLI
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Credential |
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Telephone | 203-789-2222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State | CT
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