1669924718 NPI number — EAR, NOSE AND THROAT GROUP OF CENTRAL NEW JERSEY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669924718 NPI number — EAR, NOSE AND THROAT GROUP OF CENTRAL NEW JERSEY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EAR, NOSE AND THROAT GROUP OF CENTRAL NEW JERSEY
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:
6
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:
1669924718
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/27/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
23 NEVSKY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDISON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08820-2425
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-205-1311
Provider Business Mailing Address Fax Number:
732-205-9648

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2124 OAK TREE RD FL 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDISON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08820
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-205-1311
Provider Business Practice Location Address Fax Number:
732-205-9648
Provider Enumeration Date:
10/25/2016

Additional Information

Authorized Official

Authorized Official Last Name:
PARK
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
I
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
732-205-1311

Provider Taxonomy Codes

  • Taxonomy code: 207YX0007X , with the licence number:  25MA05408700 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com