1326076316 NPI number — PHILADELPHIA EAR, NOSE & THROAT SURGICAL ASSOCIATES, PC

Table of content: (NPI 1326076316)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326076316 NPI number — PHILADELPHIA EAR, NOSE & THROAT SURGICAL ASSOCIATES, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHILADELPHIA EAR, NOSE & THROAT SURGICAL ASSOCIATES, PC
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:
1326076316
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2340 E ALLEGHENY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19134-4433
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-423-6670
Provider Business Mailing Address Fax Number:
215-423-7787

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2340 E ALLEGHENY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19134-4433
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-423-6670
Provider Business Practice Location Address Fax Number:
215-423-7787
Provider Enumeration Date:
06/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TOMCZAK
Authorized Official First Name:
ROSELLEN
Authorized Official Middle Name:
MEEHAN
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
215-423-6670

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  MD017012E , 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)





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