1073546859 NPI number — EAR NOSE AND THROAT ASSOCIATES INC.

Table of content: (NPI 1073546859)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073546859 NPI number — EAR NOSE AND THROAT ASSOCIATES INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EAR NOSE AND THROAT ASSOCIATES INC.
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:
EAR NOSE & THROAT ASSOC.
Provider Other Organization Name Type Code:
3
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:
1073546859
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/27/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
375 TOWNSHIP LINE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELKINS PARK
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19027
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-663-1121
Provider Business Mailing Address Fax Number:
215-663-1243

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
375 TOWNSHIP LINE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELKINS PARK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-663-1121
Provider Business Practice Location Address Fax Number:
215-663-1243
Provider Enumeration Date:
07/07/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HAMPEL
Authorized Official First Name:
AVRAHAM
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
215-663-1121

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X , with the licence number:  MD020113E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0659388 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".