Healthcare Provider Details

I. General information

NPI: 1558496109
Provider Name (Legal Business Name): ASSOCIATED EAR, NOSE & THROAT SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 02/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 FARMINGTON AVE STE 3
WEST HARTFORD CT
06119-1418
US

IV. Provider business mailing address

901 FARMINGTON AVE STE 3
WEST HARTFORD CT
06119-1418
US

V. Phone/Fax

Practice location:
  • Phone: 860-586-2111
  • Fax: 860-586-2114
Mailing address:
  • Phone: 860-586-2111
  • Fax: 860-586-2114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. TODD ZACHS
Title or Position: PARTNER
Credential: M.D.
Phone: 860-586-2111