Organization Active NPI

Middlesex Urology, PC.

  • Urology Physician
  • Middletown, CT
National Provider Identifier
1790873453
Registry record updated Jan 26, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
Legal business name
MIDDLESEX UROLOGY, PC.
Practice address
520 Saybrook Rd
Suite 100B
Middletown, CT 06457-4700
Phone
(860) 347-8850
Fax
(860) 347-6774
NPI assigned
Oct 10, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Sheryl A Mala
Title
Practice Administrator
Phone
(860) 347-8850

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208800000X Primary

Addresses

Primary practice location

520 Saybrook Rd
Suite 100B
Middletown, CT 06457-4700

Mailing address

520 Saybrook Rd
Suite 100B
Middletown, CT 06457-4700
Phone (860) 347-8850

Other identifiers 4

IdentifierTypeStateIssuer
001222751MedicaidCT
001160332MedicaidCT
001170919MedicaidCT
001346677MedicaidCT

National Provider Directory

National Provider Directory

Locations

520 Saybrook Rd
Middletown, CT 06457
Phone (860) 346-2608

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1327536000000",
    "number": "1790873453",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "520 SAYBROOK RD",
            "address_2": "SUITE 100B",
            "city": "MIDDLETOWN",
            "state": "CT",
            "postal_code": "064574700",
            "telephone_number": "860-347-8850",
            "fax_number": "860-347-6774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 SAYBROOK RD",
            "address_2": "SUITE 100B",
            "city": "MIDDLETOWN",
            "state": "CT",
            "postal_code": "064574700",
            "telephone_number": "860-347-8850",
            "fax_number": "860-347-6774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDDLESEX UROLOGY, PC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-10",
        "last_updated": "2012-01-26",
        "status": "A",
        "authorized_official_last_name": "MALA",
        "authorized_official_first_name": "SHERYL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "860-347-8850"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001222751",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001160332",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001170919",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001346677",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Middletown, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.