1730417247 NPI number — ALLERGY EAR NOSE AND THROAT INC

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 1730417247 NPI number — ALLERGY EAR NOSE AND THROAT INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALLERGY EAR NOSE AND THROAT 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:
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:
1730417247
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/03/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5701 OVERSEAS HWY
Provider Second Line Business Mailing Address:
UNIT 17
Provider Business Mailing Address City Name:
MARATHON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33050-2784
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-675-6700
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5701 OVERSEAS HWY
Provider Second Line Business Practice Location Address:
UNIT 17
Provider Business Practice Location Address City Name:
MARATHON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33050-2784
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-675-6700
Provider Business Practice Location Address Fax Number:
305-743-2115
Provider Enumeration Date:
11/20/2009

Additional Information

Authorized Official

Authorized Official Last Name:
CONSIGLIO
Authorized Official First Name:
ANGELO
Authorized Official Middle Name:
ROBERT
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
630-675-6700

Provider Taxonomy Codes

  • Taxonomy code: 207K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Y00000X , with the licence number: ME101216 , 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)





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