Provider Demographics
NPI:1194735894
Name:UROLOGICAL ASSOCIATES OF CENTRAL CT
Entity type:Organization
Organization Name:UROLOGICAL ASSOCIATES OF CENTRAL CT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DELEGATED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:R
Authorized Official - Last Name:KURZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-238-1241
Mailing Address - Street 1:455 LEWIS AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06451-2121
Mailing Address - Country:US
Mailing Address - Phone:203-238-1241
Mailing Address - Fax:
Practice Address - Street 1:455 LEWIS AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06451-2121
Practice Address - Country:US
Practice Address - Phone:203-238-1241
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0602010013Medicare NSC
CTC00281Medicare PIN