Provider Demographics
NPI:1588751069
Name:BROOME UROLOGICAL ASSOCIATES, L.L.P.
Entity type:Organization
Organization Name:BROOME UROLOGICAL ASSOCIATES, L.L.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:607-729-7666
Mailing Address - Street 1:169 RIVERSIDE DR
Mailing Address - Street 2:DEPAUL PAVILION
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-4246
Mailing Address - Country:US
Mailing Address - Phone:607-729-7666
Mailing Address - Fax:607-729-7667
Practice Address - Street 1:169 RIVERSIDE DR
Practice Address - Street 2:DEPAUL PAVILION
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905-4246
Practice Address - Country:US
Practice Address - Phone:607-729-7666
Practice Address - Fax:607-729-7667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY56639AMedicare ID - Type Unspecified