1275727828 NPI number — CHILDREN'S E.N.T., P.C.

Table of content: (NPI 1275727828)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275727828 NPI number — CHILDREN'S E.N.T., P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHILDREN'S E.N.T., P.C.
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:
MICHAEL P. PIZZUTO, MD, PC
Provider Other Organization Name Type Code:
4
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:
1275727828
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/25/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
908 NIAGARA FALLS BLVD
Provider Second Line Business Mailing Address:
STE 208
Provider Business Mailing Address City Name:
N TONAWANDA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14120-2019
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-692-2160
Provider Business Mailing Address Fax Number:
716-332-3658

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8207 MAIN STREET STE 5
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILLIAMSVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14221
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-362-9730
Provider Business Practice Location Address Fax Number:
716-213-0348
Provider Enumeration Date:
08/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PIZZUTO
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
PAUL
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
716-632-2000

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X , with the licence number:  168257 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207YP0228X , with the licence number: 168257 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1003690 . This is a "IHA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01247209 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00010139101 . This is a "UNIVERA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000511120011 . This is a "BLUE CROSS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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