Provider Demographics
NPI:1992322457
Name:ADVANCED UROLOGY CT LLC
Entity type:Organization
Organization Name:ADVANCED UROLOGY CT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-502-8227
Mailing Address - Street 1:55 GREENS FARMS RD STE 200-78
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-6149
Mailing Address - Country:US
Mailing Address - Phone:917-502-8227
Mailing Address - Fax:
Practice Address - Street 1:116 MASON ST
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-2607
Practice Address - Country:US
Practice Address - Phone:917-502-8227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-01
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty