1316938806 NPI number — EAR NOSE & THROAT FACIAL SUGERY CENTER PA

Table of content: (NPI 1316938806)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316938806 NPI number — EAR NOSE & THROAT FACIAL SUGERY CENTER PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EAR NOSE & THROAT FACIAL SUGERY CENTER PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316938806
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1726 MEDICAL BLVD
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
NAPLES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34110-1426
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-594-7774
Provider Business Mailing Address Fax Number:
239-594-5974

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1726 MEDICAL BLVD
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
NAPLES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34110-1426
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-594-7774
Provider Business Practice Location Address Fax Number:
239-594-5974
Provider Enumeration Date:
11/02/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MALIK
Authorized Official First Name:
CARILYN
Authorized Official Middle Name:
JUNE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
239-594-7774

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X , with the licence number:  ME86099 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com